Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Institute of Biomedical Investigation August Pi I Sunyer, Barcelona, Spain; Hepatic and Digestive Diseases Biomedical Investigation Center, Madrid, Spain.
Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Lancet. 2021 Oct 9;398(10308):1359-1376. doi: 10.1016/S0140-6736(21)01374-X. Epub 2021 Sep 17.
Cirrhosis is widely prevalent worldwide and can be a consequence of different causes, such as obesity, non-alcoholic fatty liver disease, high alcohol consumption, hepatitis B or C infection, autoimmune diseases, cholestatic diseases, and iron or copper overload. Cirrhosis develops after a long period of inflammation that results in replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules, leading to portal hypertension. The disease evolves from an asymptomatic phase (compensated cirrhosis) to a symptomatic phase (decompensated cirrhosis), the complications of which often result in hospitalisation, impaired quality of life, and high mortality. Progressive portal hypertension, systemic inflammation, and liver failure drive disease outcomes. The management of liver cirrhosis is centred on the treatment of the causes and complications, and liver transplantation can be required in some cases. In this Seminar, we discuss the disease burden, pathophysiology, and recommendations for the diagnosis and management of cirrhosis and its complications. Future challenges include better screening for early fibrosis or cirrhosis, early identification and reversal of causative factors, and prevention of complications.
肝硬化在全球广泛流行，可由多种病因引起，如肥胖、非酒精性脂肪性肝病、大量饮酒、乙型或丙型肝炎感染、自身免疫性疾病、胆汁淤积性疾病以及铁或铜过载等。肝硬化在长期炎症后发展而来，炎症导致健康的肝实质被纤维组织和再生结节所取代，进而引起门静脉高压。该疾病由无症状期（代偿期肝硬化）进展为有症状期（失代偿期肝硬化），其并发症常导致住院、生活质量受损和高死亡率。进行性门静脉高压、全身炎症和肝功能衰竭导致疾病结局恶化。肝硬化的管理重点在于针对病因和并发症进行治疗，某些情况下可能需要进行肝移植。在本次学术研讨会上，我们将讨论肝硬化的疾病负担、病理生理学以及肝硬化及其并发症的诊断和管理建议。未来的挑战包括更好地进行早期纤维化或肝硬化筛查、早期识别和逆转病因以及预防并发症。
