Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia.
Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia.
Nutrients. 2023 Dec 21;16(1):35. doi: 10.3390/nu16010035.
Malnutrition and sarcopenia are highly prevalent in patients with decompensated cirrhosis and are associated with poorer clinical outcomes. Their pathophysiology is complex and multifactorial, with protein-calorie malnutrition, systemic inflammation, reduced glycogen stores and hormonal imbalances all well reported. The direct contribution of portal hypertension to these driving factors is however not widely documented in the literature. This review details the specific mechanisms by which portal hypertension directly contributes to the development of malnutrition and sarcopenia in cirrhosis. We summarise the existing literature describing treatment strategies that specifically aim to reduce portal pressures and their impact on nutritional and muscle outcomes, which is particularly relevant to those with end-stage disease awaiting liver transplantation.
营养不良和肌肉减少症在失代偿性肝硬化患者中非常普遍，并且与较差的临床结局相关。其病理生理学复杂且多因素，已有充分报道的包括蛋白质-热量营养不良、全身炎症、糖原储存减少和激素失衡。然而，门脉高压对这些驱动因素的直接贡献在文献中并未广泛记录。这篇综述详细介绍了门脉高压如何直接导致肝硬化中营养不良和肌肉减少症的发展的具体机制。我们总结了现有的文献描述了专门旨在降低门脉压的治疗策略及其对营养和肌肉结果的影响，这对于那些等待肝移植的终末期疾病患者尤为重要。
