肝硬化门静脉高压性胃病的发病机制及抗酸剂的治疗应用

杨宗国; 张建良

doi:10.3969/j.issn.1001-5256.2017.11.037

肝硬化门静脉高压性胃病的发病机制及抗酸剂的治疗应用

DOI: 10.3969/j.issn.1001-5256.2017.11.037

上海市公共卫生临床中心

基金项目:

北京医卫健康公益基金会项目；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 1706
- HTML全文浏览量: 26
- PDF下载量: 429
- 被引次数: 0
出版历程
- 收稿日期: 2017-05-27
- 出版日期: 2017-11-20

Pathogenesis of portal hypertensive gastropathy in cirrhotic patients and the application of antacids in treatment

Shanghai Public Health Clinical Center

Research funding:

摘要

摘要: 肝硬化门静脉高压性胃病(PHG)的发病率高,并发上消化道出血的风险大。胃黏膜损伤是其主要的病理改变,抗酸剂在肝硬化PHG中的应用研究较少且存在争议。对PHG的影响因素、胃黏膜损伤机制及抗酸剂的应用进行了概括。认为治疗PHG过程中,在降低门静脉压力的同时使用质子泵抑制剂等抑酸药物可提高PHG的治愈率。但不同抑酸药物干预肝硬化PHG的疗效及安全性进行客观评价仍需通过前瞻性、大样本、随机对照试验进一步证实。
- 门静脉高压性胃病 /
- 肝硬化 /
- 抗酸剂 /
- 综述
Abstract: Portal hypertensive gastropathy (PHG) has a high incidence rate in cirrhotic patients, leading to a high risk of upper gastrointestinal bleeding.Gastric mucosal injury is the major pathological change of PHG.There are few studies focusing on the clinical application of antacids in the treatment of PHG in cirrhotic patients and there are still controversies over this issue.This article reviews the influencing factors for PHG, the mechanism of gastric mucosal injury, and the application of antacids.It is pointed out that during the treatment of PHG, besides the reduction in portal venous pressure, the application of antacids such as proton pump inhibitors can improve the cure rate of PHG.Prospective randomized control trials with a large sample size are needed to further demonstrate the clinical effect and safety of antacids in the treatment of PHG in cirrhotic patients.
- portal hypertensive gastropathy /
- liver cirrhosis /
- antacids /
- review

HTML全文

参考文献(35)

[1]MESIHOVIC R, PROHIC D, GRIBAJCEVIC M, et al.Portal hypertensive gastropathy (PHG) [J].Med Arh, 2004, 58 (6) :377-379.

[2]ZHAO HW, JIN R, NING HJ.Research advances in portal hypertensive gastropathy[J].J Clin Hepatol, 2006, 22 (3) :225-227. (in Chinese) 赵海文, 金瑞, 宁慧娟.门脉高压性胃病的研究进展[J].临床肝胆病杂志, 2006, 22 (3) :225-227.

[3]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :203-218. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-218.

[4]CURVELO LA, BRABOSA W, RHOR R, et al.Underlying mechanism of portal hypertensive gastropathy in cirrhosis:a hemodynamic and morphological approach[J].J Gastroenterol Hepatol, 2009, 24 (9) :1541-1546.

[5]LI R, MAO H, HUANG CC.Research advances in the pathogenesis of portal hypertensive gastropathy[J].Int J Dig Dis, 2011, 31 (5) :277-279. (in Chinese) 李瑞, 毛华, 黄春炽.门脉高压性胃病发病机制的研究进展[J].国际消化病杂志, 2011, 31 (5) :277-279.

[6]MERKEL C, SCHIPILLITI M, BIGHIN R, et al.Portal hypertension and portal hypertensive gastropathy in patients with liver cirrhosis:a haemodynamic study[J].Dig Liver Dis, 2003, 35 (4) :269-274.

[7]KIM MY, CHOI H, BAIK SK, et al.Portal hypertensive gastropathy:correlation with portal hypertension and prognosis in cirrhosis[J].Dig Dis Sci, 2010, 55 (12) :3561-3567.

[8]WU FT.Related factors for portal hypertensive gastropathy[J].Shandong Med J, 2005, 45 (25) :65. (in Chinese) 吴凤婷.门脉高压性胃病的相关因素分析[J].山东医药, 2005, 45 (25) :65.

[9]YU ZR, WEI GX, LIU QC, et al.Risk factors of HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding[J].J Clin Hepatol, 2017, 33 (5) :860-863. (in Chinese) 于芝瑞, 魏国喜, 刘其昌, 等.HBV相关肝硬化并发急性上消化道出血的危险因素分析[J].临床肝胆病杂志, 2017, 33 (5) :860-863.

[10]CHEN GZ, LI GX, MAO DW, et al.Association of portal hypertensive gastropathy with esophageal varices, liver function, and Helicobacter pylori infection[J].Clin Focus, 2005, 20 (12) :686-687. (in Chinese) 陈国忠, 李贵贤, 毛德文, 等.门脉高压性胃病与食管静脉曲张、肝功能及幽门螺杆菌感染的关系[J].临床荟萃, 2005, 20 (12) :686-687.

[11]XIAO ZH, DONG JE, LI SF.Association of the degree of esophageal varices with portal hypertensive gastropathy and bleeding[J].Hainan Med J, 2004, 15 (6) :59-60. (in Chinese) 肖宗汉, 董金娥, 李珊芬.食管静脉曲张程度与门静脉高压性胃病及出血关系探讨[J].海南医学, 2004, 15 (6) :59-60.

[12]WANG S, WEN W, YAO P, et al.Clinical analysis of portal hypertensive gastropathy in patients with hepatocirrhosis[J].World Chin J Dig, 2006, 14 (5) :533-535. (in Chinese) 王帅, 闻炜, 姚鹏, 等.肝硬化并门脉高压性胃病的临床研究[J].世界华人消化杂志, 2006, 14 (5) :533-535.

[13]SHI GL.Gastroscopy and analysis of portal hypertensive gastropathy in the patients with hepatocirrhosis[J].J Chin Practical Diagn and Ther, 2007, 21 (2) :117-118. (in Chinese) 石国梁.肝硬化患者门脉高压性胃病的胃镜检查与分析[J].中华实用诊断与治疗杂志, 2007, 21 (2) :117-118.

[14]MERLI M, NICOLINI G, ANGELONI S, et al.The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension[J].Am J Gastroenterol, 2004, 99 (10) :1959-1965.

[15]GARCIA-TSAO G.Portal hypertension[J].Curr Opin Gastroenterol, 2006, 22 (3) :254-262.

[16] PIQUE JM, LEUNG FW, KITAHORA T, et al.Gastric mucosal blood flow and acid secretion in portal hypertensive rats[J].Gastroenterology, 1988, 95 (3) :727-733.

[17]QIU X, LI CF.Research advances in the pathogenesis of portal hypertensive gastropathy[J].J Clin Hepatol, 2004, 20 (2) :123-124. (in Chinese) 邱香, 李传凤.门脉高压性胃病发病机制的研究进展[J].临床肝胆病杂志, 2004, 20 (2) :123-124.

[18]TIAN ZB, WANG YK, LIU ZZ.Research advances in portal hypertensive gastropathy[J].Chin J Gerontol, 2011, 31 (14) :2805-2807. (in Chinese) 田宗彪, 王英凯, 刘振珍.门脉高压性胃病的研究进展[J].中国老年学杂志, 2011, 31 (14) :2805-2807.

[19]DUANMU Z, WECKLE A, KOUKOURITAKI SB, et al.Developmental expression of aryl, estrogen, and hydroxysteroid sulfotransferases in pre-and postnatal human liver[J].J Pharmacol Exp T-her, 2006, 316 (3) :1310-1317.

[20]YANG XZ, WANG Q, ZHOU XR.Diagnosis and treatment of portal hypertensive gastropathy complicated by bleeding[J].Chin JDig Endosc, 2002, 19 (1) :31-32. (in Chinese) 杨晓钟, 王琼, 周锡荣.门静脉高压性胃病并出血的诊治[J].中华消化内镜杂志, 2002, 19 (1) :31-32.

[21]ZHOU YN, PENG GY, WU J.Comparison of octreotide, vasopressin, and omeprazole in patients with acute bleeding portalhypertensive gastropathy:a controlled study[J].World Chin J Dig, 2002, 10 (2) :197-200. (in Chinese) 周永宁, 彭贵勇, 吴静.奥曲肽、垂体后叶素和奥美拉唑治疗门脉高压性胃病急性出血的对照研究[J].世界华人消化杂志, 2002, 10 (2) :197-200.

[22]YU SH.Clinical observation of ilaprazole combined with Kangfuxin solution in the treatment of portal hypertensive gastropathy[J].Chin JClin Ration Drug Use, 2013, 6 (31) :34-35. (in Chinese) 于生河.艾普拉唑联合康复新液治疗门脉高压性胃病的临床观察[J].临床合理用药杂志, 2013, 6 (31) :34-35.

[23]CHEN SH, ZHAO MH, LIU JY.Clinical effect of antacids combined with propranolol in prevention of bleeding caused by portal hypertensive gastropathy[J].J Chin Physician, 2004, S1:213-214. (in Chinese) 陈诗焕, 赵敏辉, 刘君艳.抑酸剂联合心得安预防门脉高压性胃病出血疗效观察[J].中国医师杂志, 2004, S1:213-214.

[24]ZHU BX.Clinical analysis on portal hypertensive gastropathy treated with omeprazole[J].Chin J New Drugs, 2007, 16 (13) :1041-1043. (in Chinese) 朱炳喜.奥美拉唑治疗门脉高压性胃病的临床研究[J].中国新药杂志, 2007, 16 (13) :1041-1043.

[25]XIE RD, CHEN LL.The Curative effect of different drugs in patients with portal hypertensive gastropathy[J].China Mod Doct, 2008, 46 (18) :30-31. (in Chinese) 谢荣迪, 陈林莉.不同药物治疗门脉高压性胃病疗效比较[J].中国现代医生, 2008, 46 (18) :30-31.

[26]YEN HH, YANG CW, SU WW, et al.Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with pepticulcer bleeding after successful endoscopic therapy[J].BMCGastroenterol, 2012, 12:66.

[27]PANG SH, GRAHAM DY.A clinical guide to using intravenous proton-pump inhibitors in reflux and peptic ulcers[J].Therap Adv Gastroenterol, 2010, 3 (1) :11-22.

[28]ZHOU Y, QIAO L, WU J, et al.Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy:a controlled study[J].J Gastroenterol Hepatol, 2002, 17 (9) :973-979.

[29]GJEORGJIEVSKI M, CAPPELL MS.Portal hypertensive gastropathy:a systematic review of the pathophysiology, clinical presentation, natural history and therapy[J].World J Hepatol, 2016, 8 (4) :231-262.

[30]ZHU B, ZHANG FB, LIU W.Treatment for portal hypertensive gastrpathy with proton pump inhibitor plus H2 receptor antagonist[J].Anhui Med J, 2008, 29 (6) :713-714. (in Chinese) 朱斌, 章福彬, 刘卫.质子泵抑制剂联合H2受体拮抗剂治疗门脉高压性胃病[J].安徽医学, 2008, 29 (6) :713-714.

[31]TREVINO HH, BRADY CE 3rd, SCHENKER S.Portal hypertensive gastropathy[J].Dig Dis, 1996, 14 (4) :258-270.

[32]PAN WD, XUN RY, CHEN YM.Correlations of portal hypertensive gastropathy of hepatitis B cirrhosis with other factors[J].Hepatobiliary Pancreat Dis Int, 2002, 1 (4) :527-531.

[33]SMART HL, TRIGER DR.Clinical features, pathophysiology and relevance of portal hypertensive gastropathy[J].Endoscopy, 1991, 23 (4) :224-228.

[34]PIQUE JM, LEUNG FW, KITAHORA T, et al.Gastric mucosal blood flow and acid secretion in portal hypertensive rats[J].Gastroenterology, 1988, 95 (3) :727-733.

[35]BENOIT JN, BARROWMAN JA, HARPER SL, et al.Role of humoral factors in the intestinal hyperemia associated with chronic portal hypertension[J].Am J Physiol, 1984, 247 (5 Pt 1) :g486-g493.

施引文献

资源附件(0)

访问统计