失代偿期肝硬化患者再代偿的长期预后

谢志伟; 李波; 林丽花; 谭颖; 李剑萍; 关玉娟; 王亚萍

doi:10.12449/JCH260602

失代偿期肝硬化患者再代偿的长期预后

DOI: 10.12449/JCH260602

广州医科大学附属市八医院肝病科，广州 510440

基金项目:

广东省医学科学技术研究基金 (A2024653);

广州市市校（院）企联合资助项目 (2025A03J3731);

广州市市校（院）企联合资助项目 (2024A03J0860);

广州医科大学科研能力提升计划重大临床研究项目 (GMUCR2024-02027)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：谢志伟负责文章设计和撰写；李波、林丽花、谭颖负责查阅文献；李剑萍、关玉娟、王亚萍负责拟定文章思路，修改并最终定稿。

详细信息

通信作者:
王亚萍， xiruo0833@sina.com （ORCID： 0000-0002-0609-9115）

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出版历程
- 收稿日期: 2026-03-15
- 录用日期: 2026-04-09
- 出版日期: 2026-06-25

Long-term prognosis of recompensation in patients with decompensated liver cirrhosis

Department of Hepatology，Guangzhou Eighth People’s Hospital，Guangzhou Medical University，Guangzhou 510440，China

Research funding:

Medical Science and Technology Research Fund of Guangdong Province (A2024653);

Guangzhou Municipal-University/Institutes-Enterprises Joint Funding Project (2025A03J3731);

Guangzhou Municipal-University/Institutes-Enterprises Joint Funding Project (2024A03J0860);

Major Clinical Research Project of the Scientific Research Capacity Enhancement Program of Guangzhou Medical University (GMUCR2024-02027)

More Information

Corresponding author: WANG Yaping， xiruo0833@sina.com （ORCID： 0000-0002-0609-9115）

摘要

摘要: 肝硬化再代偿指失代偿期肝硬化患者经病因治疗或对症治疗后，失代偿并发症消失，肝功能及临床表型恢复至代偿期状态的过程。近年来，随着肝硬化病因的有效控制和对失代偿并发症的治疗或预防，再代偿的临床意义日益受到关注。本文从再代偿的定义与诊断标准、影响因素、对长期预后的影响机制及临床管理策略几个方面展开综述，结合最新研究证据探讨其在改善患者生存质量、降低终末期事件风险中的核心价值，为优化肝硬化全程管理提供依据。
- 肝硬化再代偿 /
- 诊断 /
- 预后
Abstract: Liver cirrhosis recompensation refers to the process in which patients with decompensated cirrhosis achieve the disappearance of decompensated complications and restoration of liver function and clinical phenotype to a compensated state after etiological treatment or symptomatic treatment. In recent years， with effective control of the etiology of cirrhosis and treatment or prevention of decompensated complications， the clinical significance of recompensation has gained increasing attention. This article elaborates on recompensation from the aspects of definition， diagnostic criteria， influencing factors， mechanisms affecting long-term prognosis， and clinical management strategies， and with reference to the latest research evidence， this article also discusses the core value of recompensation in improving quality of life and reducing the risk of end-stage events， in order to provide a basis for optimizing the comprehensive management of liver cirrhosis.
- Recompensated Cirrhosis /
- Diagnosis /
- Prognosis

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图 1 肝硬化自然史

Figure 1. The natural history of liver cirrhosis

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表 1 不同国家及地区对失代偿期肝硬化再代偿的定义

Table 1. Definitions of liver cirrhosis recompensation across different countries and regions

国家	年份	主要定义
中国	2017年^［7］	乙型肝炎、丙型肝炎相关肝硬化失代偿期患者给予及时抗病毒、抗炎保肝等治疗，患者肝功能明显改善，无腹水等并发症
加拿大	2017年^［9］	未针对并发症预防性治疗且不再出现腹水、肝性胸腔积液及周围组织水肿、肝性脑病、消化道出血等失代偿事件；MELD评分降至15分，且持续≥6个月
中国	2019年^［10］	肝硬化患者出现失代偿后，由于病因控制或治疗等原因，肝功能逐渐恢复并稳定，在较长时间内未再出现肝硬化失代偿事件
欧洲	2021年^［11］	需符合以下所有标准：（1）消除或控制肝脏疾病的主要病因，例如：严格戒酒或肝炎病毒的清除或抑制；（2）临床症状消失，如腹腔积液（不同时使用利尿剂）、肝性脑病（不使用预防性药物）、至少12个月无静脉曲张出血复发；（3）肝功能检查指标的稳定改善，如血清白蛋白、国际标准化比值和总胆红素水平
中国	2022年^［12］	在病因消除或控制的基础上，至少1年内未再出现腹水、肝性脑病、食管胃静脉曲张出血等严重并发症（停用药物治疗），伴稳定的肝功能改善，具体标准为：MELD评分<10分和/或Child-Pugh分级A级（白蛋白>35 g/L、国际标准化比值<1.5、总胆红素<34 μmol/L）
韩国	2022年^［13］	Child-Pugh分级B、C级的乙型肝炎患者，首次失代偿事件后开始抗病毒治疗，治疗后肝功能改善至 Child-Pugh评分5分
注：MELD，终末期肝病模型；Child-Pugh分级，蔡尔德-皮尤分级。

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表 2 不同病因失代偿期肝硬化的再代偿发生率

Table 2. Recompensation incidence rates in decompensated liver cirrhosis with different etiologies

类型	随访时间（年）	再代偿发生率（%）
乙型肝炎^{［8， 15］}	1	53
	2.5	56.2
	5	53
丙型肝炎^［16-18］	1.4	24.7
	5	29.03
	8.4	36.6
酒精性肝病^［19-20］	2	18.1
酒精性肝病^［19-20］	3	31.1
自身免疫性肝病^［21-22］	3.5	16.7
自身免疫性肝病^［21-22］	4.2	15.3

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