PDF(Pubmed)
Abstract：
Cirrhosis consists of 2 main stages: compensated and decompensated, the latter defined by the development/presence of ascites, variceal hemorrhage, and hepatic encephalopathy. The survival rate is entirely different, depending on the stage. Treatment with nonselective β-blockers prevents decompensation in patients with clinically significant portal hypertension, changing the previous paradigm based on the presence of varices. In patients with acute variceal hemorrhage at high risk of failure with standard treatment (defined as those with a Child-Pugh score of 10-13 or those with a Child-Pugh score of 8-9 with active bleeding at endoscopy), a pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) improves the mortality rate and has become the standard of care in many centers. In patients with bleeding from gastrofundal varices, retrograde transvenous obliteration (in those with a gastrorenal shunt) and/or variceal cyanoacrylate injection have emerged as alternatives to TIPS. In patients with ascites, emerging evidence suggests that TIPS might be used earlier, before strict criteria for refractory ascites are met. Long-term albumin use is under assessment for improving the prognosis of patients with uncomplicated ascites and confirmatory studies are ongoing. Hepatorenal syndrome is the least common cause of acute kidney injury in cirrhosis, and first-line treatment is the combination of terlipressin and albumin. Hepatic encephalopathy has a profound impact on the quality of life of patients with cirrhosis. Lactulose and rifaximin are first- and second-line treatments for hepatic encephalopathy, respectively. Newer therapies such as L-ornithine L-aspartate and albumin require further assessment.
摘要：
肝硬化包括2个主要阶段：补偿和失代偿，后者由腹水的发展/存在定义，静脉曲张出血,和肝性脑病.存活率完全不同，取决于舞台。用非选择性β受体阻滞剂治疗可预防临床上显着门静脉高压症患者的代偿失调，根据静脉曲张的存在改变以前的范式。对于标准治疗失败风险较高的急性静脉曲张出血患者（定义为Child-Pugh评分为10-13的患者或Child-Pugh评分为8-9的患者，内镜检查时出现活动性出血），抢先的经颈静脉肝内门体分流术(TIPS)可提高死亡率,并已成为许多中心的标准治疗.胃底静脉曲张出血的患者，逆行经静脉闭塞(在有胃肾分流的患者中)和/或静脉曲张氰基丙烯酸酯注射液已成为TIPS的替代方法.在腹水患者中，新出现的证据表明TIPS可能更早使用，在达到难治性腹水的严格标准之前。长期白蛋白使用正在评估中，以改善无并发症腹水患者的预后，并且正在进行确证研究。肝肾综合征是肝硬化急性肾损伤最不常见的原因,一线治疗是特利加压素和白蛋白的联合治疗。肝性脑病对肝硬化患者的生活质量有深远的影响。乳果糖和利福昔明是肝性脑病的一线和二线治疗，分别。较新的疗法如L-鸟氨酸L-天冬氨酸和白蛋白需要进一步评估。
