Flamm Steven L
Section of Gastroenterology and Hepatology, Rush University Medical School, Chicago, Ill.
Am J Med. 2024 Oct;137(10):929-938. doi: 10.1016/j.amjmed.2024.05.015. Epub 2024 May 22.
Cirrhosis is a prevalent, chronic condition with an asymptomatic compensated phase, in which patients may feel well, and a decompensated phase that begins with the onset of complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding). Because patients with cirrhosis may appear healthy with normal liver enzymes, alkaline phosphatase, and serum bilirubin levels, awareness of clinical signals is important. For example, patients with thrombocytopenia should be evaluated for chronic liver disease and cirrhosis. Early recognition and management of cirrhosis-related complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding) are important, given their association with hospitalization and poor prognosis (eg increased odds of short-term mortality). Hepatic encephalopathy can be the most subtle cirrhosis-related complication and associated cognitive impairment may be misdiagnosed. Because hepatic encephalopathy can be associated with hospital readmissions, reducing readmission rates after hepatic encephalopathy-related hospitalizations is critical. This includes incorporating ongoing therapy (eg rifaximin plus lactulose) in postdischarge management plans to reduce the risk of hepatic encephalopathy recurrence. Strategies that mitigate cirrhosis progression and prevent the development of cirrhosis-related complications are key to improving patient outcomes.
肝硬化是一种常见的慢性疾病，有一个无症状的代偿期，在此阶段患者可能感觉良好，还有一个失代偿期，始于并发症（如肝性脑病、腹水和/或静脉曲张出血）的出现。由于肝硬化患者的肝酶、碱性磷酸酶和血清胆红素水平可能正常，看起来健康，因此认识临床信号很重要。例如，血小板减少的患者应评估是否患有慢性肝病和肝硬化。鉴于肝硬化相关并发症（如肝性脑病、腹水和/或静脉曲张出血）与住院及不良预后（如短期死亡率增加）相关，早期识别和处理这些并发症很重要。肝性脑病可能是最隐匿的肝硬化相关并发症，相关的认知障碍可能被误诊。由于肝性脑病可能与再次住院有关，降低肝性脑病相关住院后的再入院率至关重要。这包括在出院后管理计划中纳入持续治疗（如利福昔明加乳果糖），以降低肝性脑病复发的风险。减轻肝硬化进展并预防肝硬化相关并发症发生的策略是改善患者预后的关键。
