University of Texas Southwestern Medical Center, Division of Digestive and Liver Disease and the Department of Internal Medicine, Dallas, Texas 75390-8887, USA.
Curr Opin Gastroenterol. 2012 May;28(3):223-9. doi: 10.1097/MOG.0b013e328351d003.
Chronic liver disease (CLD) causes significant morbidity and mortality, mainly due to complications [hepatic encephalopathy, ascites, hepatorenal syndrome (HRS), and esophageal variceal hemorrhage (EVH)]. Studies of the complications, management and outcomes in patients with CLD over the past 18 months are reviewed.
Percutaneous liver biopsy can be safely performed in patients with advanced liver disease with minimal complications. Predictors of response to lactulose, probiotics and L-ornithine-L-aspartate therapy in minimal hepatic encephalopathy have been reported. Rifaximin was found to lead to better maintenance of remission and decreased re-admission rates in patients with cirrhosis and hepatic encephalopathy, and may improve driving performance in those with minimal hepatic encephalopathy. In a controversial study, patients with refractory ascites taking propranolol were found to have poorer outcomes, perhaps related to beta-blockade associated paracentesis-induced circulatory dysfunction. Terlipressin and albumin therapy currently appears to be the best medical therapy available in patients with type 1 HRS, although pentoxifylline may be effective to treat HRS in patients with cirrhosis and ascites. In patients with gastric varices, primary prophylaxis with cyanoacrylate may decrease the probability of gastric variceal hemorrhage compared to nonselective beta-blockers. In patients with esophageal varices without bleeding, prophylaxis with variceal ligation or beta-blockers was similar in terms of bleeding, mortality, and adverse events. Erythromycin given 30 min prior to endoscopic evaluation in suspected EVH was associated with an overall benefit in visibility, duration of the procedure and length of hospital stay.
Refinement in clinical management strategies for patients with cirrhosis and its complications appears to continue to contribute to improved patient outcomes.
慢性肝病（CLD）可引起较高的发病率和死亡率，主要是由于并发症[肝性脑病、腹水、肝肾综合征（HRS）和食管静脉曲张出血（EVH）]所致。本文回顾了过去 18 个月来有关 CLD 患者并发症、治疗和结局的研究。
经皮肝活检可安全用于有严重肝脏疾病的患者，且并发症很少。微小肝性脑病患者对乳果糖、益生菌和 L-鸟氨酸-L-天冬氨酸治疗的反应预测因素已被报道。利福昔明可使肝硬化和肝性脑病患者的缓解维持率提高，再入院率降低，且可能改善微小肝性脑病患者的驾驶表现。在一项有争议的研究中，服用普萘洛尔的难治性腹水患者预后较差，这可能与β受体阻滞剂相关的腹水穿刺诱导的循环功能障碍有关。特利加压素和白蛋白治疗目前似乎是 1 型 HRS 患者的最佳药物治疗方法，尽管己酮可可碱可能对肝硬化和腹水患者的 HRS 有效。对于胃静脉曲张患者，与非选择性β受体阻滞剂相比，氰基丙烯酸酯预防性治疗可降低胃静脉曲张出血的概率。对于无出血的食管静脉曲张患者，预防性结扎或β受体阻滞剂治疗在出血、死亡率和不良事件方面相似。在疑似 EVH 的患者中，在进行内镜检查前 30 分钟给予红霉素可使整体可视性、操作时间和住院时间受益。
肝硬化及其并发症患者的临床管理策略不断得到完善，似乎继续有助于改善患者的结局。
