肝硬化失代偿与“再代偿”

何志颖; 王冰琼; 尤红

doi:10.3969/j.issn.1001-5256.2022.05.006

肝硬化失代偿与“再代偿”

DOI: 10.3969/j.issn.1001-5256.2022.05.006

首都医科大学附属北京友谊医院肝病中心，国家消化系统疾病临床医学研究中心，北京 100050

基金项目:

国家自然科学基金 (82000568)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：何志颖负责文献检索，撰写文章；王冰琼指导文章撰写，修改文章关键内容；尤红拟定写作思路并最终定稿。

详细信息

通信作者:
尤红，youhongliver@ccmu.edu.cn

计量
- 文章访问数: 1833
- HTML全文浏览量: 1638
- PDF下载量: 357
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-20
- 录用日期: 2022-04-21
- 出版日期: 2022-05-20

Liver cirrhosis: Decompensation and "recompensation"

Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Research funding:

National Natural Science Foundation of China (82000568)

More Information

Corresponding author: YOU Hong, youhongliver@ccmu.edu.cn(ORCID: 0000-0001-9409-1158)

摘要

摘要: 肝硬化分期评价体系从关注疾病进展规律到进一步细化急性失代偿时疾病状态分类，提出病因治疗后失代偿期肝硬化可再代偿的概念，系统补充了失代偿期肝硬化分期评价体系，其中门静脉高压、系统性炎症变化等多种因素可影响失代偿期肝硬化的临床转归。肝硬化再代偿这一新概念的提出，需要更多的临床证据去阐明包括病毒性肝炎等在内的病因治疗后获得“再代偿”患者的临床特征及其潜在的机制。
- 肝硬化 /
- 失代偿 /
- 再代偿
Abstract: The evolution concept of decompensated cirrhosis rebuilds the clinical staging system for decompensated cirrhosis, which changes the focus from the pattern of disease progression to refining the status of acute decompensation onset and proposing "recompensation" of decompensated cirrhosis. During the process, factors such as portal hypertension and systemic inflammatory changes can affect the clinical outcome of decompensated cirrhotic patients. Significantly, more evidence is warranted to elucidate the clinical characteristics and potential mechanisms of achieving "recompensation" after etiology control, such as in viral hepatitis patients.
- Liver Cirrhosis /
- Decompensation /
- Recompensation

HTML全文

参考文献(37)

[1]	GRACIA-SANCHO J, MARRONE G, FERNÁNDEZ-IGLESIAS A. Hepatic microcirculation and mechanisms of portal hypertension[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(4): 221-234. DOI: 10.1038/s41575-018-0097-3.
[2]	TSOCHATZIS EA, BOSCH J, BURROUGHS AK. Liver cirrhosis[J]. Lancet, 2014, 383(9930): 1749-1761. DOI: 10.1016/S0140-6736(14)60121-5.
[3]	XU XY, DING HG, LI WG, et al. Chinese guidelines on the management of liver cirrhosis (abbreviated version)[J]. World J Gastroenterol, 2020, 26(45): 7088-7103. DOI: 10.3748/wjg.v26.i45.7088.
[4]	EL-SHERIF O, JIANG ZG, TAPPER EB, et al. Baseline factors associated with improvements in decompensated cirrhosis after direct-acting antiviral therapy for hepatitis C virus infection[J]. Gastroenterology, 2018, 154(8): 2111-2121.e8. DOI: 10.1053/j.gastro.2018.03.022.
[5]	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.
[6]	D'AMICO G, GARCIA-TSAO G, PAGLIARO L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies[J]. J Hepatol, 2006, 44(1): 217-231. DOI: 10.1016/j.jhep.2005.10.013.
[7]	ARVANITI V, D'AMICO G, FEDE G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis[J]. Gastroenterology, 2010, 139(4): 1246-1256.e1-5. DOI: 10.1053/j.gastro.2010.06.019.
[8]	FEDE G, D'AMICO G, ARVANITI V, et al. Renal failure and cirrhosis: a systematic review of mortality and prognosis[J]. J Hepatol, 2012, 56(4): 810-818. DOI: 10.1016/j.jhep.2011.10.016.
[9]	D'AMICO G, PASTA L, MORABITO A, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients[J]. Aliment Pharmacol Ther, 2014, 39(10): 1180-1193. DOI: 10.1111/apt.12721.
[10]	D'AMICO G, MORABITO A, D'AMICO M, et al. New concepts on the clinical course and stratification of compensated and decompensated cirrhosis[J]. Hepatol Int, 2018, 12(Suppl 1): 34-43. DOI: 10.1007/s12072-017-9808-z.
[11]	MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144(7): 1426-1437.e1-e9. DOI: 10.1053/j.gastro.2013.02.042.
[12]	TREBICKA J, FERNANDEZ J, PAPP M, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology[J]. J Hepatol, 2020, 73(4): 842-854. DOI: 10.1016/j.jhep.2020.06.013.
[13]	COSTA D, SIMBRUNNER B, JACHS M, et al. Systemic inflammation increases across distinct stages of advanced chronic liver disease and correlates with decompensation and mortality[J]. J Hepatol, 2021, 74(4): 819-828. DOI: 10.1016/j.jhep.2020.10.004.
[14]	ARROYO V, ANGELI P, MOREAU R, et al. The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis[J]. J Hepatol, 2021, 74(3): 670-685. DOI: 10.1016/j.jhep.2020.11.048.
[15]	JACHS M, HARTL L, SCHAUFLER D, et al. Amelioration of systemic inflammation in advanced chronic liver disease upon beta-blocker therapy translates into improved clinical outcomes[J]. Gut, 2021, 70(9): 1758-1767. DOI: 10.1136/gutjnl-2020-322712.
[16]	D'AMICO G, BERNARDI M, ANGELI P. Towards a new definition of decompensated cirrhosis[J]. J Hepatol, 2022, 76(1): 202-207. DOI: 10.1016/j.jhep.2021.06.018.
[17]	BALCAR L, SEMMLER G, POMEJ K, et al. Patterns of acute decompensation in hospitalized patients with cirrhosis and course of acute-on-chronic liver failure[J]. United European Gastroenterol J, 2021, 9(4): 427-437. DOI: 10.1002/ueg2.12089.
[18]	KIM TH, UM SH, LEE YS, et al. Determinants of re-compensation in patients with hepatitis B virus-related decompensated cirrhosis starting antiviral therapy[J]. Aliment Pharmacol Ther, 2022, 55(1): 83-96. DOI: 10.1111/apt.16658.
[19]	XU X, WANG H, ZHAO W, et al. Recompensation factors for patients with decompensated cirrhosis: a multicentre retrospective case-control study[J]. BMJ Open, 2021, 11(6): e043083. DOI: 10.1136/bmjopen-2020-043083.
[20]	JU YC, JUN DW, CHOI J, et al. Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis[J]. World J Gastroenterol, 2018, 24(40): 4606-4614. DOI: 10.3748/wjg.v24.i40.4606.
[21]	ZHAO H, WANG Q, LUO C, et al. Recompensation of decompensated hepatitis B cirrhosis: Current status and challenges[J]. Biomed Res Int, 2020, 2020: 9609731. DOI: 10.1155/2020/9609731.
[22]	de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno Ⅶ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
[23]	D'AMBROSIO R, AGHEMO A, RUMI MG, et al. A morphometric and immunohistochemical study to assess the benefit of a sustained virological response in hepatitis C virus patients with cirrhosis[J]. Hepatology, 2012, 56(2): 532-543. DOI: 10.1002/hep.25606.
[24]	BEDOSSA P. Reversibility of hepatitis B virus cirrhosis after therapy: who and why?[J]. Liver Int, 2015, 35(Suppl 1): 78-81. DOI: 10.1111/liv.12710.
[25]	THEISE ND, JIA J, SUN Y, et al. Progression and regression of fibrosis in viral hepatitis in the treatment era: the Beijing classification[J]. Mod Pathol, 2018, 31(8): 1191-1200. DOI: 10.1038/s41379-018-0048-0.
[26]	HSU SJ, TSAI MH, CHANG CC, et al. Extrahepatic angiogenesis hinders recovery of portal hypertension and collaterals in rats with cirrhosis resolution[J]. Clin Sci (Lond), 2018, 132(6): 669-683. DOI: 10.1042/CS20171370.
[27]	SELICEAN S, WANG C, GUIXÉ-MUNTET S, et al. Regression of portal hypertension: underlying mechanisms and therapeutic strategies[J]. Hepatol Int, 2021, 15(1): 36-50. DOI: 10.1007/s12072-021-10135-4.
[28]	ZAFRA C, ABRALDES JG, TURNES J, et al. Simvastatin enhances hepatic nitric oxide production and decreases the hepatic vascular tone in patients with cirrhosis[J]. Gastroenterology, 2004, 126(3): 749-755. DOI: 10.1053/j.gastro.2003.12.007.
[29]	MØLLER S, BENDTSEN F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis[J]. Liver Int, 2018, 38(4): 570-580. DOI: 10.1111/liv.13589.
[30]	ABRALDES JG, ALBILLOS A, BAÑARES R, et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial[J]. Gastroenterology, 2009, 136(5): 1651-1658. DOI: 10.1053/j.gastro.2009.01.043.
[31]	HUANG HC, TSAI MH, CHANG CC, et al. Microbiota transplants from feces or gut content attenuated portal hypertension and portosystemic collaterals in cirrhotic rats[J]. Clin Sci (Lond), 2021, 135(24): 2709-2728. DOI: 10.1042/CS20210602.
[32]	WU H, YAN S, WANG G, et al. von Willebrand factor as a novel noninvasive predictor of portal hypertension and esophageal varices in hepatitis B patients with cirrhosis[J]. Scand J Gastroenterol, 2015, 50(9): 1160-1169. DOI: 10.3109/00365521.2015.1037346.
[33]	WANLESS IR. The role of vascular injury and congestion in the pathogenesis of cirrhosis: the congestive escalator and the parenchymal extinction sequence[J]. Curr Hepatol Rep, 2020, 19(1): 40-53. DOI: 10.1007/s11901-020-00508-y.
[34]	VERNA EC, MORELLI G, TERRAULT NA, et al. DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort[J]. J Hepatol, 2020, 73(3): 540-548. DOI: 10.1016/j.jhep.2020.03.031.
[35]	JINDAL A, BHARDWAJ A, KUMAR G, et al. Clinical decompensation and outcomes in patients with compensated cirrhosis and a hepatic venous pressure gradient ≥20 mm Hg[J]. Am J Gastroenterol, 2020, 115(10): 1624-1633. DOI: 10.14309/ajg.0000000000000653.
[36]	TREBICKA J, AMOROS A, PITARCH C, et al. Addressing profiles of systemic inflammation across the different clinical phenotypes of acutely decompensated cirrhosis[J]. Front Immunol, 2019, 10: 476. DOI: 10.3389/fimmu.2019.00476.
[37]	MONTEIRO S, GRANDT J, USCHNER FE, et al. Differential inflammasome activation predisposes to acute-on-chronic liver failure in human and experimental cirrhosis with and without previous decompensation[J]. Gut, 2021, 70(2): 379-387. DOI: 10.1136/gutjnl-2019-320170.