肝硬化门静脉高压食管胃静脉曲张出血的防治指南

中华医学会肝病学分会; 中华医学会消化病学分会; 中华医学会消化内镜学分会

doi:10.3969/j.issn.1001-5256.2023.03.znygf

肝硬化门静脉高压食管胃静脉曲张出血的防治指南

DOI: 10.3969/j.issn.1001-5256.2023.03.znygf

利益冲突声明：所有作者均声明不存在利益冲突。

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出版历程
- 收稿日期: 2023-02-10
- 录用日期: 2023-02-15
- 出版日期: 2023-03-20

Guidelines on the management of esophagogastric variceal bleeding in cirrhotic portal hypertension

摘要

摘要:
为了规范肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理，中华医学会肝病学分会、消化病学分会和消化内镜学分会组织国内有关专家，结合近年来国内外肝硬化门静脉高压食管胃静脉曲张出血相关临床研究的最新进展，遵循循证医学的证据，修定了《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》，对肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理提出了推荐意见，旨在提高临床医生对于肝硬化门静脉高压食管胃静脉曲张出血的临床救治水平。
- 肝硬化 /
- 高血压，门静脉 /
- 食管和胃静曲张 /
- 诊疗准则
Abstract:
In order to standardize the diagnosis, treatment and management of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension, the Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association organized relevant experts, reviewed domestic and international latest progress in clinical research on EVB in cirrhotic portal hypertension, and followed the evidence of evidence-based medicine to update the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension. The guideline provides recommendations for the diagnosis, treatment and management of EVB in cirrhotic portal hypertension and aims to improve the level of clinical treatment of EVB in cirrhotic portal hypertension.
- Liver Cirrhosis /
- Hypertension, Portal /
- Esophageal and Gastric Varices /
- Practice Guideline

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图 1 肝硬化急性上消化道出血临床处理推荐流程

Figure 1. Recommened procedures for clinical treatment of acute upper gastrointestinal hemorrhage in cirrhosis

下载: 全尺寸图片幻灯片

表 1 推荐意见的证据等级和推荐强度等级

Table 1. Evidence of recommended opinions and recommended strength grade

证据质量
高(A)	进一步研究不可能改变对该疗效评估结果的可信度
中(B)	进一步研究有可能影响该疗效评估结果的可信度，且可能改变该评估结果
低或非常低(C)	进一步研究很有可能影响该疗效评估结果的可信度，且很可能改变该评估结果
推荐强度等级
强(1)	明确显示干预措施利大于弊或弊大于利
弱(2)	利弊不确定或无论质量高低的证据均显示利弊相当

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表 2 各期肝硬化临床特征

Table 2. Clinical characteristics of cirrhosis in different stages

分期	代偿期肝硬化			失代偿期肝硬化			晚期失代偿
分期	1a期	1b期	2期	3期	4期	5期	6期
特征	临床无显著门静脉高压，无消化道静脉曲张	临床有显著门静脉高压，但无消化道静脉曲张	消化道有静脉曲张，但无出血及腹水	有腹水，无消化道静脉曲张出血，伴或不伴消化道静脉曲张	有消化道静脉曲张出血，伴或不伴腹水或HE	≥2个失代偿事件	难治性腹水、持续性脑病或黄疸、感染、肾脏和其他器官功能障碍
注意要点	预防临床显著门静脉高压	预防静脉曲张等		预防失代偿期肝硬化肝功能进一步恶化，降低病死率			降低病死率
注意要点	预防肝功能失代偿

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表 3 不同病因肝硬化不同病情状态下LSM的诊断界值

Table 3. Diagnostic threshold of LSM under different conditions of cirrhosis of different etiology

常见病因	肝功情况说明	肝硬化诊断界值(kPa)	肝硬化排除界值(kPa)
慢性乙型肝炎	ULN＜ALT＜5×ULN，胆红素正常	17.0	10.6
	ALT、胆红素正常	12.0	9.0
慢性丙型肝炎	无说明	14.6	10.0
非酒精性脂肪肝病	无说明	15.0	10.0
酒精性肝病	无说明	20	12.5
注：ULN，正常值上限。

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