Berzigotti Annalisa
Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine (UVCM), Inselspital, University of Bern, MEM F807, Murtenstrasse 35, CH, 3010, Berne, Switzerland.
BMC Med. 2017 Nov 10;15(1):200. doi: 10.1186/s12916-017-0966-6.
Liver cirrhosis is the fourth cause of death in adults in Western countries, with complications of portal hypertension being responsible for most casualties. In order to reduce mortality, development of accurate diagnostic methods for early diagnosis, effective etiologic treatment, improved pharmacological therapy for portal hypertension, and effective therapies for end-stage liver failure are required.
Early detection of cirrhosis and portal hypertension is now possible using simple non-invasive methods, leading to the advancement of individualized risk stratification in clinical practice. Despite previous assumptions, cirrhosis can regress if its etiologic cause is effectively removed. Nevertheless, while this is now possible for cirrhosis caused by chronic hepatitis C, the incidence of cirrhosis due to non-alcoholic steatohepatitis has increased dramatically and effective therapies are not yet available. New drugs acting on the dynamic component of hepatic vascular resistance are being studied and will likely improve the future management of portal hypertension.
Cirrhosis is now seen as a dynamic disease able to progress and regress between the compensated and decompensated stages. This opinion article aims to provide the author's personal view of the current major advances and challenges in this field.
在西方国家，肝硬化是成年人死亡的第四大原因，门静脉高压并发症是导致大多数死亡的原因。为降低死亡率，需要开发用于早期诊断的准确诊断方法、有效的病因治疗、改进的门静脉高压药物治疗以及终末期肝衰竭的有效治疗方法。
现在使用简单的非侵入性方法可以早期检测肝硬化和门静脉高压，这推动了临床实践中个体化风险分层的进展。尽管以前有种种假设，但如果有效消除病因，肝硬化是可以逆转的。然而，虽然由慢性丙型肝炎引起的肝硬化现在可以实现这一点，但非酒精性脂肪性肝炎所致肝硬化的发病率急剧上升，且尚无有效治疗方法。作用于肝血管阻力动态成分的新药正在研究中，可能会改善未来门静脉高压的管理。
现在认为肝硬化是一种动态疾病，能够在代偿期和失代偿期之间进展和逆转。这篇观点文章旨在提供作者对该领域当前主要进展和挑战的个人看法。
