Singh Jasleen, Ebaid Mark, Saab Sammy
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Gastroenterol Rep (Oxf). 2024 Aug 5;12:goae072. doi: 10.1093/gastro/goae072. eCollection 2024.
Cirrhosis with complications of liver decompensation and hepatocellular carcinoma (HCC) constitute a leading cause of morbidity and mortality worldwide. Portal hypertension is central to the progression of liver disease and decompensation. The most recent Baveno VII guidance included revision of the nomenclature for chronic liver disease, termed compensated advanced chronic liver disease, and leveraged the use of liver stiffness measurement to categorize the degree of portal hypertension. Additionally, non-selective beta blockers, especially carvedilol, can improve portal hypertension and may even have a survival benefit. Procedural techniques with interventional radiology have become more advanced in the management of refractory ascites and variceal bleeding, leading to improved prognosis in patients with decompensated liver disease. While lactulose and rifaximin are the preferred treatments for hepatic encephalopathy, many alternative treatment options may be used in refractory cases and even procedural interventions such as shunt embolization may be of benefit. The approval of terlipressin for the treatment of hepatorenal syndrome (HRS) in the USA has improved the way in which HRS is managed and will be discussed in detail. Malnutrition, frailty, and sarcopenia lead to poorer outcomes in patients with decompensated liver disease and should be addressed in this patient population. Palliative care interventions can lead to improved quality of life and clinical outcomes. Lastly, the investigation of systemic therapies, in particular immunotherapy, has revolutionized the management of HCC. These topics will be discussed in detail in this review.
伴有肝失代偿和肝细胞癌（HCC）并发症的肝硬化是全球发病和死亡的主要原因。门静脉高压是肝病进展和失代偿的核心。最新的《巴韦诺VII共识》对慢性肝病的命名进行了修订，称为代偿期晚期慢性肝病，并利用肝脏硬度测量来对门静脉高压程度进行分类。此外，非选择性β受体阻滞剂，尤其是卡维地洛，可改善门静脉高压，甚至可能具有生存获益。介入放射学的操作技术在难治性腹水和静脉曲张出血的治疗中变得更加先进，从而改善了失代偿期肝病患者的预后。虽然乳果糖和利福昔明是肝性脑病的首选治疗方法，但在难治性病例中可使用许多替代治疗方案，甚至诸如分流栓塞等操作干预也可能有益。特利加压素在美国获批用于治疗肝肾综合征（HRS），改善了HRS的管理方式，本文将对此进行详细讨论。营养不良、衰弱和肌肉减少症会导致失代偿期肝病患者的预后更差，应对这一患者群体加以关注。姑息治疗干预可提高生活质量和临床结局。最后，全身治疗，尤其是免疫治疗的研究，彻底改变了HCC的治疗方式。这些主题将在本综述中详细讨论。
