Schwabl Philipp, Laleman Wim
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Gastroenterol Rep (Oxf). 2017 May;5(2):90-103. doi: 10.1093/gastro/gox011. Epub 2017 Apr 18.
Portal hypertension is most frequently associated with cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. As such, clinically significant portal hypertension forms the prelude to decompensation and impacts significantly on the prognosis of patients with liver cirrhosis. At present, non-selective β-blockers, vasopressin analogues and somatostatin analogues are the mainstay of treatment but these strategies are far from satisfactory and only target splanchnic hyperemia. In contrast, safe and reliable strategies to reduce the increased intrahepatic resistance in cirrhotic patients still represent a pending issue. In recent years, several preclinical and clinical trials have focused on this latter component and other therapeutic avenues. In this review, we highlight novel data in this context and address potentially interesting therapeutic options for the future.
门静脉高压最常与肝硬化相关,是诸如静脉曲张破裂出血、腹水或肝性脑病等相关并发症的主要驱动因素。因此,具有临床意义的门静脉高压是失代偿的前奏,并对肝硬化患者的预后产生重大影响。目前,非选择性β受体阻滞剂、血管加压素类似物和生长抑素类似物是主要治疗方法,但这些策略远不能令人满意,且仅针对内脏充血。相比之下,降低肝硬化患者肝内阻力增加的安全可靠策略仍是一个悬而未决的问题。近年来,一些临床前和临床试验聚焦于后一个因素及其他治疗途径。在本综述中,我们强调这方面的新数据,并探讨未来可能有趣的治疗选择。