关注重症肝病临床管理的热点问题

吕佳昱; 韩涛

doi:10.3969/j.issn.1001-5256.2017.09.001

关注重症肝病临床管理的热点问题

DOI: 10.3969/j.issn.1001-5256.2017.09.001

吕佳昱,
韩涛

天津市第三中心医院肝内科天津医科大学第三中心临床学院天津市人工细胞重点实验室天津市肝胆疾病研究所

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中图分类号: R575
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出版历程
- 收稿日期: 2017-07-07
- 出版日期: 2017-09-20

Hotspots in clinical management of severe liver diseases

Lu: JiaYu,
Han Tao

Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin Medical University, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease

摘要

摘要: 肝衰竭、急性失代偿期肝硬化等重症肝病病情危重,病死率高,其预后与早期预警、及时动态评估、综合有效的治疗密切相关。患者需要祛除致病因素、器官支持、并发症防治等一系列有效的临床管理措施。内科治疗-人工肝-肝移植是目前重症肝病的重要治疗模式。粒细胞集落刺激因子、干细胞治疗、生物型人工肝等新的探索曙光在前,非选择性β受体阻滞剂仍存在一定争议。
- 肝功能衰竭 /
- 肝硬化 /
- 肝,人工 /
- 肝移植 /
- 诊断 /
- 治疗 /
- 述评
Abstract: Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates, and the prognosis of such patients is closely associated with early warning, timely dynamic assessment, and comprehensive and effective therapy.The patients require a series of effective clinical management measures for elimination of causative factors, organ support, and prevention and treatment of complications. Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases. Granulocyte colony-stimulating factor, stem cell therapy, and bioartificial liver have a promising future, while there are still controversies over non-selective β-blocker. This article reviews the hotspots in the clinical management of severe liver diseases.
- liver failure /
- liver cirrhosis /
- liver, artificial /
- liver transplantation /
- diagnosis /
- treatment /
- editorial

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参考文献(22)

[1]European Association for the Study of the Liver.EASL clinical practical guidelines on the management of acute (fulminant) liver failure[J].J Hepatol, 2017, 66 (5) :1047-1081.

[2]DURAND F, NADIM MK.Management of acute-on-chronic liver failure[J].Semin Liver Dis, 2016, 36 (2) :141-152.

[3]HAN T, ZHANG YL.Predictive and prognostic evaluation of hepatitis B virus-induced liver failure[J].J Clin Hepatol, 2015, 31 (4) :505-509. (in Chinese) 韩涛, 张玉玲.乙型肝炎肝衰竭的早期预警及预后评价[J].临床肝胆病杂志, 2015, 31 (4) :505-509.

[4]JALAN R, FERNANDEZ J, WIEST R, et al.Bacterial infections in cirrhosis:a position statement based on the EASL Special Conference 2013[J].J Hepatol, 2014, 60 (6) :1310-1324.

[5] Liver Failure and Artificial Liver Group, Branch of Infectious Disease, Chinese Medical Association.Guideline for non-bioartificial liver support systems in treatment of liver failure:2016 update[J].Chin J Clin Infect Dis, 2016, 9 (2) :97-103. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组.《非生物型人工肝治疗肝衰竭指南 (2016年版) 》[J].中华临床感染病杂志, 2016, 9 (2) :97-103.

[6]THANDASSERY RB, MONTANO-LOZA AJ.Role of nutrition and muscle in cirrhosis[J].Curr Treat Options Gastroenterol, 2016, 14 (2) :257-273.

[7]DASARATHY S, MERLI M.Sarcopenia from mechanism to diagnosis and treatment in liver disease[J].J Hepatol, 2016, 65 (6) :1232-1244.

[8]KAMACHI S, MIZUTA T, OTSUKA T, et al.Sarcopenia is a risk factor for the recurrence of hepatocellular carcinoma after curative treatment[J].Hepatol Res, 2016, 46 (2) :201-208.

[9]McC LAVE SA, TAYLOR BE, MARTINDALE RG, et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J].JPEN J Parenter Enteral Nutr, 2016, 40 (2) :159-211.

[10]Beijing Medical Association, Committee of Parenteral and Enteral Nutrition;Expert Panel on Consensus on the Parenteral and Enteral Nutritional and the Dietary Intervention for Patients with Chronic Liver Diseases.Consensus on the clinical nutritional intervention for patients with chronic liver disease[J].J Clin Hepatol, 2017, 33 (7) :1236-1245. (in Chinese) 北京医学会肠外肠内营养学专业委员会, 《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会.慢性肝病患者肠外肠内营养支持与膳食干预专家共识[J].临床肝胆病杂志, 2017, 33 (7) :1236-1245.

[11]RACHAKONDA V, BORHANI AA, DUNN MA, et al.Serum leptin is a biomarker of malnutrition in decompensated cirrhosis[J].PLoS One, 2016, 11 (9) :e0159142.

[12]NIE CY, HAN T, ZHANG L, et al.Cross-sectional and dynamic change of serum metabolite profiling for hepatitis B-related acuteon-chronic liver failure by UPLC/MS[J].J Viral Hepat, 2014, 21 (1) :53-63.

[13]YE Q, YIN WL, Zhang L, et al.The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis[J].PLoS One, 2017, 12 (4) :e0175165.

[14]DI CC, ZOCCO MA, SAULNIER N, et al.Safety and efficacy profile of G-CSF therapy in patients with acute on chronic liver failure[J].Dig Liver Dis, 2007, 39 (12) :1071-1076.

[15]GARG V, GARG H, KHAN A, et al.Granulocyte colony-stimulating factor mobilizes CD34 (+) cells and improves survival of patients with acute-on-chronic liver failure[J].Gastroenterology, 2012, 142 (3) :505-512.

[16]DUAN XZ, LIU FF, TONG JJ, et al.Granulocyte-colony stimulating factor therapy improves survival in patients with hepatitis B virus-associated acute-on-chronic liver failure[J].World J Gastroenterol, 2013, 19 (7) :1104-1110.

[17]SERSTE T, MELOT C, FRANCOZ C, et al.Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology, 2010, 52 (3) :1017-1022.

[18]MANDORFER M, BOTA S, SCHWABL P, et al.Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis[J].Gastroenterology, 2014, 146 (7) :1680-1690.

[19]MOOKERJEE RP, PAVESI M, THOMSEN KL, et al.Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure[J].J Hepatol, 2016, 64 (3) :574-582.

[20]NJEI B, MCCARTY TR, GARCIA-TSAO G.Beta-blockers in patients with cirrhosis and ascites:type of beta-blocker matters[J].Gut, 2016, 65 (8) :1393-1394.

[21]MADSEN BS, NIELSEN KF, FIALLA AD, et al.Keep the sick from harm in spontaneous bacterial peritonitis:dose of beta blockers matters[J].J Hepatol, 2016, 64 (6) :1455-1456.

[22]HANNOUN Z, STEICHEN C, DIANAT N, et al.The potential of induced pluripotent stem cell derived hepatocytes[J].J Hepatol, 2016, 65 (1) :182-199.

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