Prima Clinica Medica, Sapienza-University of Rome, Italy.
Eur J Intern Med. 2010 Apr;21(2):62-4. doi: 10.1016/j.ejim.2010.01.005. Epub 2010 Feb 18.
Variceal hemorrhage is a major cause of death in patients with cirrhosis. Much still could be performed in clinical practice to reduce the risk for bleeding in cirrhotic patients and accurate predictive rules should be provided for early recognition of high-risk patients. Liver cirrhosis patients present a complex hemostatic dysfunction with prolongation of bleeding time, chronic coagulation activation, and secondary hyperfibrinolysis. Therefore, liver failure determines an acquired coagulopathy that has been considered to be one potential underlying mechanism of bleeding. Endotoxemia may play a pivotal role in activating clotting system in portal and systemic circulation and it could represent a common mechanism accounting for portal vein thrombosis, systemic hyperfibrinolysis and eventually gastrointestinal bleeding. Nevertheless, clinical trials should also be planned to investigate the causal relationship between acquired coagulopathy and bleeding in patients with chronic liver disease.
静脉曲张出血是肝硬化患者死亡的主要原因。在临床实践中，仍有许多措施可以降低肝硬化患者出血的风险，并且应该提供准确的预测规则，以便早期识别高危患者。肝硬化患者存在复杂的止血功能障碍，表现为出血时间延长、慢性凝血激活和继发性纤维蛋白溶解亢进。因此，肝功能衰竭导致获得性凝血障碍，这被认为是出血的潜在机制之一。内毒素血症可能在门静脉和全身循环中激活凝血系统中起关键作用，它可能代表了导致门静脉血栓形成、全身纤维蛋白溶解亢进，最终导致胃肠道出血的共同机制。然而，还应计划临床试验来研究慢性肝病患者获得性凝血障碍与出血之间的因果关系。
