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肝硬化终末期患者的治疗和管理

杨明 黄缘 魏来

杨明, 黄缘, 魏来. 肝硬化终末期患者的治疗和管理[J]. 临床肝胆病杂志, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007
引用本文: 杨明, 黄缘, 魏来. 肝硬化终末期患者的治疗和管理[J]. 临床肝胆病杂志, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007
YANG M, HUANG Y, WEI L. Treatment and man-agement of patients with end-stage liver cirrhosis[J]. J Clin Hepatol, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007
Citation: YANG M, HUANG Y, WEI L. Treatment and man-agement of patients with end-stage liver cirrhosis[J]. J Clin Hepatol, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007

肝硬化终末期患者的治疗和管理

DOI: 10.3969/j.issn.1001-5256.2021.01.007
详细信息
    作者简介:

    杨明(1982—),女,副主任医师,博士,主要从事病毒性肝炎、脂肪肝、肝硬化及并发症、肝癌综合治疗研究

    通讯作者:

    魏来,weilai@mail.tsinghua.edu.cn

  • 作者贡献声明:杨明负责课题设计,资料分析,撰写论文;黄缘参与收集数据,修改论文;魏来负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R575.2

Treatment and management of patients with end-stage liver cirrhosis

  • 摘要: 肝硬化终末期通常指肝硬化失代偿期所致的慢性肝衰竭,为人类健康带来沉重负担。肝移植是最为有效的治疗,但受肝源缺乏、费用高昂等因素的严重限制。人工肝往往作为桥接治疗。细胞治疗的发展为其带来新的希望。探讨了肝硬化终末期病因治疗及并发症的管理,介绍了肝硬化终末期进行人工肝、细胞治疗、肝移植的适应证和时机。
  • [1] Chinese Society of Hepatology, Chinese Medical Association.Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.11.006

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006
    [2] JIA JD.Diagnosis and treatment of end-stage liver disease[J]. Chin J Hepatol, 2007, 15(6): 401-402.(in Chinese) DOI: 10.3760/j.issn:1007-3418.2007.06.001

    贾继东. 终末期肝病的诊疗现状[J]. 中华肝脏病杂志, 2007, 15(6): 401-402. DOI: 10.3760/j.issn:1007-3418.2007.06.001
    [3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guideline for diagnosis and treatment of liver failure (2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.01.007

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007
    [4] Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.12.007

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007
    [5] JANG JW, CHOI JY, KIM YS, et al. Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus-related cirrhosis[J]. Hepatology, 2015, 61(6): 1809-1820. DOI: 10.1002/hep.27723
    [6] LANGE CM, BOJUNGA J, HOFMANN WP, et al. Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function[J]. Hepatology, 2009, 50(6): 2001-2006. DOI: 10.1002/hep.23346
    [7] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C (2019 version)[J]. J Clin Hepatol, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008

    中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008
    [8] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015)[J]. J Clin Hepatol, 2016, 32(1): 9-22.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.01.002

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015)[J]. 临床肝胆病杂志, 2016, 32(1): 9-22. DOI: 10.3969/j.issn.1001-5256.2016.01.002
    [9] Chinese Society of Hepatology, Chinese MedicalAssociation.Guidelines on the management of ascites andcomplications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2017.10.003

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003
    [10] GABA RC, PARVINIAN A, CASADABAN LC, et al. Survival benefit of TIPS versus serial paracentesis in patients with refractory ascites:A single institution case-control propensity score analysis[J]. Clin Radiol, 2015, 70(5): e51-e57. DOI: 10.1016/j.crad.2015.02.002
    [11] GUO TT, YANG Y, SONG Y, et al. Effects of midodrine in patients with ascites due to cirrhosis:Systematic review and meta-analysis[J]. J Dig Dis, 2016, 17(1): 11-19. DOI: 10.1111/1751-2980.12304
    [12] TAN HK, JAMES PD, SNIDERMAN KW, et al. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with TIPS insertion[J]. J Gastroenterol Hepatol, 2015, 30(2): 389-395. DOI: 10.1111/jgh.12725
    [13] SCHEPIS F, VIZZUTTI F, GARCIA-TSAO G, et al. Under-dilated TIPS associate with efficacy and reduced encephalopathy in a prospective, non-randomized study of patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2018, 16(7): 1153-1162. DOI: 10.1016/j.cgh.2018.01.029
    [14] ANGELI P, WONG F, WATSON H, et al. Hyponatremia in cirrhosis:Results of a patient population survey[J]. Hepatology, 2006, 44(6): 1535-1542. DOI: 10.1002/hep.21412
    [15] ALUKAL JJ, JOHN S, THULUVATH PJ. Hyponatremia in cirrhosis:An update[J]. Am J Gastroenterol, 2020, 115(11): 1775-1785. DOI: 10.14309/ajg.0000000000000786
    [16] CARACENI P, RIGGIO O, ANGELI P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): An open-label randomized trial[J]. Lancet, 2018, 391(10138): 2417-2429. DOI: 10.1016/S0140-6736(18)30840-7
    [17] WONG F, WATSON H, GERBES A, et al. Satavaptan for the management of ascites in cirrhosis: Efficacy and safety across the spectrum of ascites severity[J]. Gut, 2012, 61(1): 108-116. DOI: 10.1136/gutjnl-2011-300157
    [18] ADEBAYO D, NEONG SF, WONG F. Refractory ascites in liver cirrhosis[J]. Am J Gastroenterol, 2019, 114(1): 40-47. DOI: 10.1038/s41395-018-0185-6
    [19] FUHRMANN V, KROWKA M.Hepatopulmonary syndrome[J]. J Hepatol, 2018, 69(3): 744-745. DOI: 10.1016/j.jhep.2018.01.002
    [20] National Health Commission of the people's Republic of China.Basic principles and core policies for the allocation and sharing of human organs in China.National Health Commission of the People's Republic of China (2018) No.24[S/OL].[2018-08-03].http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=d35d96f2db82403ebe2ba41f2c583896.(in Chinese)

    中华人民共和国国家卫生健康委员会. 中国人体器官分配与共享基本原则和核心政策. 国卫医发[2018]24号[S/OL].[2018-08-03].http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=d35d96f2db82403ebe2ba41f2c583896.
    [21] NAGUEH SF, SMISETH OA, APPLETON CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography:An update from the American society of echocardiography and the European association of cardiovascular imaging[J]. Eur Heart J Cardiovasc Imaging, 2016, 17(12): 1321-1360. DOI: 10.1093/ehjci/jew082
    [22] European Association for the Study of the Liver.EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024
    [23] KJAERGARD LL, LIU J, ALS-NIELSEN B, et al. Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: A systematic review[J]. JAMA, 2003, 289(2): 217-222. DOI: 10.1001/jama.289.2.217
    [24] HANISH SI, STEIN DM, SCALEA JR, et al. Molecular adsorbent recirculating system effectively replaces hepatic function in severe acute liver failure[J]. Ann Surg, 2017, 266(4): 677-684. DOI: 10.1097/SLA.0000000000002361
    [25] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association.Guideline for non-bioartificial liver support systems in treatment of liver failure:2016 update[J]. Chin J Clin Infect Dis, 2016, 9(2): 97-103.(in Chinese) DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001

    中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016年版)[J]. 中华临床感染病杂志, 2016, 9(2): 97-103. DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001
    [26] LING Q, XU X, WEI Q, et al. Downgrading MELD improves the outcomes after liver transplantation in patients with acute-on-chronic hepatitis B liver failure[J]. PLoS One, 2012, 7(1): e30322. DOI: 10.1371/journal.pone.0030322
    [27] ANDERSON TN, ZARRINPAR A. Hepatocyte transplantation:Past efforts, current technology, and future expansion of therapeutic potential[J]. J Surg Res, 2018, 226:48-55. DOI: 10.1016/j.jss.2018.01.031
    [28] KHARAZIHA P, HELLSTRÖM PM, NOORINAYER B, et al. Improvement of liver function in liver cirrhosis patients after autologous mesenchymal stem cell injection:A phase Ⅰ-Ⅱ clinical trial[J]. Eur J Gastroenterol Hepatol, 2009, 21(10): 1199-1205. DOI: 10.1097/MEG.0b013e32832a1f6c
    [29] PENG L, XIE DY, LIN BL, et al. Autologous bone marrow mesenchymal stem cell transplantation in liver failure patients caused by hepatitis B: Short-term and long-term outcomes[J]. Hepatology, 2011, 54(3): 820-828. DOI: 10.1002/hep.24434
    [30] SUK KT, YOON JH, KIM MY, et al. Transplantation with autologous bone marrow-derived mesenchymal stem cells for alcoholic cirrhosis: Phase 2 trial[J]. Hepatology, 2016, 64(6): 2185-2197. DOI: 10.1002/hep.28693
    [31] SALAMA H, ZEKRI AR, ZERN M, et al. Autologous hematopoietic stem cell transplantation in 48 patients with end-stage chronic liver diseases[J]. Cell Transplant, 2010, 19(11): 1475-1486. DOI: 10.3727/096368910X514314
    [32] NEWSOME PN, FOX R, KING AL, et al. Granulocyte colony-stimulating factor and autologous CD133-positive stem-cell therapy in liver cirrhosis (REALISTIC): An open-label, randomised, controlled phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2018, 3(1): 25-36. DOI: 10.1016/S2468-1253(17)30326-6
    [33] ADAM R, KARAM V, DELVART V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR)[J]. J Hepatol, 2012, 57(3): 675-688. DOI: 10.1016/j.jhep.2012.04.015
    [34] MURRAY KF, CARITHERS RL Jr, AASLD. AASLD practice guidelines: Evaluation of the patient for liver transplantation[J]. Hepatology, 2005, 41(6): 1407-1432. DOI: 10.1002/hep.20704
    [35] MERION RM, SCHAUBEL DE, DYKSTRA DM, et al. The survival benefit of liver transplantation[J]. Am J Transplant, 2005, 5(2): 307-313. DOI: 10.1111/j.1600-6143.2004.00703.x
    [36] MARTIN P, DIMARTINI A, FENG S, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation[J]. Hepatology, 2014, 59(3): 1144-1165. DOI: 10.1002/hep.26972
    [37] European Association for the Study of the Liver. EASL clinical practice guidelines: Liver transplantation[J]. J Hepatol, 2016, 64(2): 433-485. DOI: 10.1016/j.jhep.2015.10.006
    [38] Chinese Society of Organ Transplantation, Chinese Medical Association.Technical specifications for selection and preoperative evaluation of liver transplantation recipients in China (version 2019)[J]. J Clin Hepatol, 2020, 36(1): 40-43.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.01.007

    中华医学会器官移植学分会. 中国肝移植受者选择与术前评估技术规范(2019版)[J]. 临床肝胆病杂志, 2020, 36(1): 40-43. DOI: 10.3969/j.issn.1001-5256.2020.01.007
    [39] WIESNER R, EDWARDS E, FREEMAN R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers[J]. Gastroenterology, 2003, 124(1): 91-96. DOI: 10.1053/gast.2003.50016
    [40] FREEMAN RB Jr, GISH RG, HARPER A, et al. Model for end-stage liver disease (MELD) exception guidelines:Results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula[J]. Liver Transpl, 2006, 12(12 Suppl 3): s128-s136. http://www.onacademic.com/detail/journal_1000033877317610_95be.html
    [41] BURRA P, GERMANI G, ADAM R, et al. Liver transplantation for HBV-related cirrhosis in Europe: An ELTR study on evolution and outcomes[J]. J Hepatol, 2013, 58(2): 287-296. DOI: 10.1016/j.jhep.2012.10.016
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  • 收稿日期:  2020-10-12
  • 修回日期:  2020-11-23
  • 刊出日期:  2021-01-18
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