Zaccherini Giacomo, Tufoni Manuel, Bernardi Mauro, Caraceni Paolo
Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy.
IRCCS AOU di Bologna-Policlinico di S. Orsola, 40138 Bologna, Italy.
J Clin Med. 2021 Oct 5;10(19):4590. doi: 10.3390/jcm10194590.
The current therapeutic strategies for the management of patients with cirrhosis rely on the prevention or treatment of specific complications. The removal of the causative agents (i.e., viruses or alcohol) prevents decompensation in the vast majority of patients with compensated cirrhosis. In contrast, even when etiological treatment has been effective, a significant proportion of patients with decompensated cirrhosis remains at risk of further disease progression. Therefore, therapies targeting specific key points in the complex pathophysiological cascade of decompensated cirrhosis could represent a new approach for the management of these severely ill patients. Some of the interventions currently employed for treating or preventing specific complications of cirrhosis or used in other diseases (i.e., poorly absorbable oral antibiotics, statins, albumin) have been proposed as potential disease-modifying agents in cirrhosis (DMAC) since clinical studies have shown their capacity of improving survival. Additional multicenter, large randomized clinical trials are awaited to confirm these promising results. Finally, new drugs able to antagonize key pathophysiological mechanisms are under pre-clinical development or at the initial stages of clinical assessment.
目前肝硬化患者的治疗策略依赖于预防或治疗特定并发症。去除病因（即病毒或酒精）可防止绝大多数代偿期肝硬化患者出现失代偿。相比之下，即使病因治疗有效，仍有相当一部分失代偿期肝硬化患者面临疾病进一步进展的风险。因此，针对失代偿期肝硬化复杂病理生理级联反应中的特定关键点进行治疗，可能为这些重症患者的管理提供一种新方法。由于临床研究已显示某些目前用于治疗或预防肝硬化特定并发症或用于其他疾病（即难吸收的口服抗生素、他汀类药物、白蛋白）的干预措施具有改善生存率的能力，它们已被提议作为肝硬化潜在的疾病修饰药物（DMAC）。还需更多多中心、大型随机临床试验来证实这些有前景的结果。最后，能够拮抗关键病理生理机制的新药正处于临床前研发阶段或临床评估初期。
