Knotek M, Rogachev B, Schrier R W
University of Colorado Health Sciences Center, Denver 80262, USA.
Can J Gastroenterol. 2000 Nov;14 Suppl D:112D-121D. doi: 10.1155/2000/340128.
In cirrhosis of the liver, according to the peripheral arterial vasodilation hypothesis, relative underfilling of the arterial tree triggers a neurohumoral response (activation of renin-angiotensin-aldosterone system, sympathetic nervous system, nonosmotic release of vasopressin) aimed at restoring circulatory integrity by promoting renal sodium and water retention. Evidence has accumulated for a major role of increased vascular production of nitric oxide as the primary cause of arterial vasodilation in cirrhosis. Ascites is a common complication in cirrhosis. Treatment of ascites consists of a low salt diet with diuretics, and paracentesis together with plasma volume expanders in diuretic-resistant patients. Progression of cirrhosis may result in hepatorenal syndrome, a state of functional renal failure that carries an ominous prognosis. Orthotopic liver transplantation has remained the only curative treatment for patients with advanced liver disease; other modalities such as transjugular intrahepatic portosystemic shunt or vasopressin analogues may serve as a bridge to transplantation. Another complication of decompensated cirrhosis is spontaneous bacterial peritonitis, the incidence of which can be reduced by primary or secondary antibiotic prophylaxis by using orally active antibiotics.
在肝硬化中,根据外周动脉血管舒张假说,动脉系统的相对血容量不足会引发一种神经体液反应(肾素-血管紧张素-醛固酮系统、交感神经系统激活,血管加压素的非渗透压性释放),旨在通过促进肾脏钠和水潴留来恢复循环完整性。越来越多的证据表明,一氧化氮血管生成增加作为肝硬化中动脉血管舒张的主要原因起着重要作用。腹水是肝硬化的常见并发症。腹水的治疗包括低盐饮食加利尿剂,对于利尿剂抵抗的患者,进行腹腔穿刺放液并同时使用血浆扩容剂。肝硬化的进展可能导致肝肾综合征,这是一种功能性肾衰竭状态,预后不佳。原位肝移植仍然是晚期肝病患者唯一的治愈性治疗方法;其他方式如经颈静脉肝内门体分流术或血管加压素类似物可作为移植的桥梁。失代偿期肝硬化的另一个并发症是自发性细菌性腹膜炎,通过使用口服活性抗生素进行一级或二级抗生素预防可降低其发生率。