Premkumar Madhumita, Anand Anil C
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India.
J Clin Exp Hepatol. 2022 Jul-Aug;12(4):1150-1174. doi: 10.1016/j.jceh.2022.04.021. Epub 2022 May 14.
Cirrhosis is the outcome of chronic liver disease of any etiology due to progressive liver injury and fibrosis. Consequently, cirrhosis leads to portal hypertension and liver dysfunction, progressing to complications like ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, cirrhotic cardiomyopathy, sarcopenia, hepatocellular carcinoma, and coagulation disorders. End-stage liver disease leads to an impaired quality of life, loss of social and economic productivity, and reduced survival.
This narrative review explains the pathophysiology of complications of cirrhosis, the diagnostic approach and innovative management, with focus on data from India. A comprehensive literature search of the published data was performed in regard with the spectrum, diagnosis, and management of cirrhosis and its complications.
There is a change in the epidemiology of metabolic syndrome, lifestyle diseases, alcohol consumption and the spectrum of etiological diagnosis in patients with cirrhosis. With the advent of universal vaccination and efficacious long-term viral suppression agents for chronic hepatitis B, availability of direct-acting antiviral agents for chronic hepatitis C, and a booming liver transplantation programme across the country, the management of complications is essential. There are several updates in the standard of care in the management of complications of cirrhosis, such as hepatorenal syndrome, hepatocellular carcinoma, and hepatic encephalopathy, and new therapies that address supportive and palliative care in advanced cirrhosis.
Prevention, early diagnosis, appropriate management of complications, timely transplantation are cornerstones in the management protocol of cirrhosis and portal hypertension. India needs improved access to care, outreach of public health programmes for viral hepatitis care, health infrastructure, and disease registries for improved healthcare outcomes. Low-cost initiatives like immunization, alcohol cessation, awareness about liver diseases, viral hepatitis elimination, and patient focused decision-making algorithms are essential to manage liver disease in India.
肝硬化是任何病因引起的慢性肝病由于进行性肝损伤和纤维化所导致的结果。因此，肝硬化会导致门静脉高压和肝功能障碍，并进展为腹水、静脉曲张出血、肝性脑病、肝肾综合征、肝肺综合征、肝硬化性心肌病、肌肉减少症、肝细胞癌和凝血障碍等并发症。终末期肝病会导致生活质量受损、社会和经济生产力丧失以及生存率降低。
本叙述性综述解释了肝硬化并发症的病理生理学、诊断方法和创新管理，重点关注来自印度的数据。针对肝硬化及其并发症的范围、诊断和管理，对已发表的数据进行了全面的文献检索。
肝硬化患者的代谢综合征、生活方式疾病、酒精消费的流行病学以及病因诊断范围发生了变化。随着普遍接种疫苗和用于慢性乙型肝炎的有效长期病毒抑制药物的出现、用于慢性丙型肝炎的直接抗病毒药物的可得性以及全国范围内蓬勃发展的肝移植项目，并发症的管理至关重要。在肝硬化并发症（如肝肾综合征、肝细胞癌和肝性脑病）的管理护理标准方面有多项更新，以及针对晚期肝硬化的支持性和姑息性护理的新疗法。
预防、早期诊断、并发症的适当管理、及时移植是肝硬化和门静脉高压管理方案的基石。印度需要改善医疗服务的可及性、扩大病毒性肝炎护理公共卫生项目的覆盖范围、改善卫生基础设施以及建立疾病登记系统以提高医疗保健效果。免疫接种、戒酒、肝病 awareness（此处原文有误，推测可能是awareness，意为意识）、消除病毒性肝炎以及以患者为中心的决策算法等低成本举措对于印度的肝病管理至关重要。
