肝硬化门静脉高压相关并发症的防治原则

韦炜; 洪依萍

doi:10.3969/j.issn.1001-5256.2021.01.005

肝硬化门静脉高压相关并发症的防治原则

DOI: 10.3969/j.issn.1001-5256.2021.01.005

韦炜^1, ,,
洪依萍²

1.
浙江大学医学院附属第二医院消化科，杭州 310009
2.
浙江大学医学院附属金华医院消化科，浙江金华 321000

作者贡献声明：韦炜负责拟定写作思路，指导撰写文章并最后定稿; 洪依萍参与文献以及数据等部分资料的收集。

详细信息

作者简介:
韦炜(1973—)，男，主任医师，主要从事消化病肝病学研究

通信作者:
韦炜，jhweiw@163.com

中图分类号: R575.2
计量
- 文章访问数: 1131
- HTML全文浏览量: 231
- PDF下载量: 218
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-10
- 录用日期: 2020-11-20
- 出版日期: 2021-01-20

Principles for the prevention and treatment of complications related to cirrhotic portal hypertension

Wei WEI^{1
, ,},
Yiping HONG²

1.
Department of Gastroenterology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China
2.
Department of Gastroenterology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China

摘要

摘要: 肝硬化是引起门静脉高压症的最常见原因。门静脉高压症可以引起食管胃静脉曲张、自发性腹膜炎、肝肾综合征以及肝性脑病等并发症，对于门静脉高压规范化诊疗应重视原发病与全程治疗，强调早筛早诊、积极预防、合理救治等链条式全病程管理，对患者制订个体化、精准化管理的预防和治疗方案。
- 肝硬化 /
- 门静脉高压 /
- 食管和胃静脉曲张 /
- 腹膜炎 /
- 肝肾综合征 /
- 肝性脑病
Abstract: Liver cirrhosis is the most common cause of portal hypertension. Portal hypertension can cause complications such as esophageal and gastric varices, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. For the standardized diagnosis and treatment of portal hypertension, we should pay attention to primary diseases and whole-course treatment, emphasize whole-course chain management including early screening and early diagnosis, active prevention, and reasonable emergency treatment, and formulate individualized and precise prevention and treatment plans for patients.
- Liver Cirrhosis /
- Portal Hypertension /
- Esophageal and Gastric Varices /
- Peritonitis /
- Hepatorenal Syndrome /
- Hepatic Encephalopathy

HTML全文

参考文献(32)

[1]	Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS); Minimally Invasive Intervention Collaborative Group, Chinese Society of Gastroenterology; Emergency Intervention Committee, Chinese College of Interventionalists, et al. Consensus on clinical application of hepatic venous pressure gradient in China (2018)[J]. J Clin Hepatol, 2018, 34(12): 2526-2536.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.12.008 中国门静脉高压诊断与监测研究组(CHESS), 中华医学会消化病学分会微创介入协作组, 中国医师协会介入医师分会急诊介入专业委员会, 等. 中国肝静脉压力梯度临床应用专家共识(2018版)[J]. 临床肝胆病杂志, 2018, 34(12): 2526-2536. DOI: 10.3969/j.issn.1001-5256.2018.12.008
[2]	MCDONALD SA, BARCLAY ST, HUTCHINSON SJ, et al. Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005-2016: A national database linkage study[J]. Aliment Pharmacol Ther, 2019, 50(4): 425-434. DOI: 10.1111/apt.15320
[3]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portalhy pertension[J]. J Clin Hepatol, 2016, 32(2): 203-219.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.02.002 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002
[4]	de FRANCHIS R, Baveno VI Faculty.Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752. DOI: 10.1016/j.jhep.2015.05.022
[5]	GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis:Risk stratification, diagnosis, and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906
[6]	GROSZMANN RJ, GARCIA-TSAO G, BOSCH J, et al. Beta-blockersto prevent gastroesophageal varices inpatients with cirrhosis[J]. N Engl J Med, 2005, 353(21): 2254-2261. DOI: 10.1056/NEJMoa044456
[7]	TRIPATHl D, STANLEY AJ, HAYES PC, et al. U.K.guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015, 64(11): 1680-1704. DOI: 10.1136/gutjnl-2015-309262
[8]	VILLANUEVA C, ALBILLOS A, GENESCÀ J, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): A randomised, double-blind, placebo-controlled, multicentretrial[J]. Lancet, 2019, 393(10181): 1597-1608. DOI: 10.1016/S0140-6736(18)31875-0
[9]	SHARMAM, SINGHS, DESAIV, et al. Comparison of therapies for primary prevention of esophageal variceal bleeding: A systematic review and network meta-analysis[J]. Hepatology, 2019, 69(4): 1657-1675. DOI: 10.1002/hep.30220
[10]	ABRALDES JG, VILLANUEVA C, ARACIL C, et al. Addition of simvastatin to standard therapy for the prevention of variceal rebleeding does not reduce rebleeding but increases survival inpatientswithcirrhosis[J]. Gastroenterology, 2016, 150(5): 1160-1170. DOI: 10.1053/j.gastro.2016.01.004
[11]	GLUUD LL, KRAG A.Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults[J]. ochrane Database Syst Rev, 2012, (8): CD004544. DOI: 10.1021/cs300439n
[12]	MISHRASR, SHARMABC, KUMARA, et al. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: A randomized controlled trial[J]. J Hepatol, 2011, 54(6): 1161-1167. DOI: 10.1016/j.jhep.2010.09.031
[13]	Cooperation Group for the Survey of Octreotide.Efficacy of octreotide in the treatment of acute variceal bleeding in cirrhotic patients: A prospective, multicentric and randomized clinical trial[J]. Chin J Dig, 2005, 25(1): 37-40.(in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHX20050100C.htm 奥曲肽全国协作组. 两种剂量奥曲肽治疗食管、胃静脉曲张大出血多中心随机对照临床疗效观察[J]. 中华消化杂志, 2005, 25(1): 37-40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHX20050100C.htm
[14]	RÖSSLE M. TIPS: 25 years later[J]. J Hepatol, 2013, 59(5): 1081-1093. DOI: 10.1016/j.jhep.2013.06.014
[15]	SUHOCKI PV, LUNGREN MP, KAPOOR B, et al. Transjugular intrahepatic portosystemic shunt complications: Prevention and management[J]. Semin Intervent Radiol, 2015, 32(2): 123-132. DOI: 10.1055/s-0035-1549376
[16]	SIRAMOLPIWAT S. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications[J]. World J Gastroenterol, 2014, 20(45): 16996-17010. DOI: 10.3748/wjg.v20.i45.16996
[17]	SINAGRA E, PERRICONE G, D'AMICO M, et al. Systematic review with meta-analysis: The haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis[J]. Aliment Pharmacol Ther, 2014, 39(6): 557-568. DOI: 10.1111/apt.12634
[18]	FUNAKOSHI N, SÉGALAS-LARGEY F, DUNY Y, et al. Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis[J]. World J Gastroenterol, 2010, 16(47): 5982-5992. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=99804006&site=ehost-live
[19]	Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association.Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Dig Surg, 2019, 18(12): 1087-1093.(in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201912001.htm 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(12): 1087-1093. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201912001.htm
[20]	WIEST R, KRAG A, GERBES A. Spontaneous bacterial peritonitis:Recent guidelines and beyond[J]. Gut, 2012, 61(2): 297-310. DOI: 10.1136/gutjnl-2011-300779
[21]	SORT P, NAVASA M, ARROYO V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. N Engl J Med, 1999, 341(6): 403-409. DOI: 10.1056/NEJM199908053410603
[22]	European Association for the Study of the Liver.EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024
[23]	ANGELI P, GINÈS P, WONG F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis:Revised consensus recommendations of the International Club of Ascites[J]. J Hepatol, 2015, 62(4): 968-974. DOI: 10.1016/j.jhep.2014.12.029
[24]	GLUUD LL, CHRISTENSEN K, CHRISTENSEN E, et al. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome[J]. Hepatology, 2010, 51(2): 576-584. DOI: 10.1002/hep.23286
[25]	SCHRIER RW, GROSS P, GHEORGHIADE M, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia[J]. N Engl J Med, 2006, 355(20): 2099-2112. DOI: 10.1056/NEJMoa065181
[26]	BOYER TD, SANYAL AJ, GARCIA-TSAO G, et al. Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1[J]. Liver Transpl, 2011, 17(11): 1328-1332. DOI: 10.1002/lt.22395
[27]	BOSSEN L, KRAG A, VILSTRUP H, et al. Nonselective β-blockers do not affect mortality in cirrhosis patients with ascites:Post Hoc analysis of three randomized controlled trials with 1198 patients[J]. Hepatology, 2016, 63(6): 1968-1976. DOI: 10.1002/hep.28352
[28]	European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J]. J Hepatol, 2010, 53(3): 397-417. DOI: 10.1016/j.jhep.2010.05.004
[29]	VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the American Association for the study of liver diseases and the European association for the study of the liver[J]. Hepatology, 2014, 60(2): 715-735. http://smartsearch.nstl.gov.cn/paper_detail.html?id=a143843e7c57d8399c66edd16c8be158
[30]	Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.10.007 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007
[31]	ZHU GQ, SHI KQ, HUANG S, et al. Systematic review with net-work meta-analysis:The comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy[J]. Aliment Phamacol Ther, 2015, 41(7): 624-635. DOI: 10.1111/apt.13122
[32]	QI XL.Full-course management of portal hypertension:Simplicity is the ultimate sophistication[J]. Chin J Hepatol, 2020, 28(9): 721-723.(in Chinese) 祁小龙. 门静脉高压全病程管理:至繁归于至简[J]. 中华肝脏病杂志, 2020, 28(9): 721-723.