特利加压素在肝硬化并发症临床应用的实践指导(2021版)

中华医学会消化病学分会肝胆疾病学组; 中国研究型医院学会肝病专业委员会

doi:10.3969/j.issn.1001-5256.2022.08.006

特利加压素在肝硬化并发症临床应用的实践指导(2021版)

DOI: 10.3969/j.issn.1001-5256.2022.08.006

利益冲突：专家组所有成员均声明不存在利益冲突

通信作者：谢渭芬, weifenxie@medmail.com.cn; 郭晓钟, guoxiaozhong1962@163.com; 杨永平, ypy_med@126.com; 祁兴顺, xingshunqi@126.com
[本文英文版首次发表在Therapeutic Advance in Gastroenterology, 2022, 15: 1-19. DOI: 10.1177/17562848221098253;中文版由《中华消化杂志》《临床肝胆病杂志》《中华肝脏病杂志》同期发表]

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出版历程
- 收稿日期: 2022-05-16
- 出版日期: 2022-08-20

Practice guidance for the use of terlipressin for liver cirrhosis related complications (2021)

摘要

摘要: 肝硬化患病人数多、死亡风险高，是全球疾病负担的重要组成部分之一。近年来，特利加压素在肝硬化相关并发症中的作用已逐渐得到认可。中华医学会消化病学分会肝胆疾病学组和中国研究型医院学会肝病专业委员会组织国内消化内科、肝病、感染性疾病、外科, 以及临床药学领域的专家，在系统回顾当前循证医学证据的基础上，结合各位专家的临床经验，共制定了10条有关特利加压素在肝硬化并发症中临床应用的实践指导声明。特利加压素可使肝硬化伴急性静脉曲张出血或肝肾综合征患者获益，但在肝硬化伴腹水、穿刺后循环功能障碍、细菌感染, 以及接受肝切除或肝移植术的患者中的应用证据仍不充分；此外，使用特利加压素时应密切监测不良事件的发生，主要包括胃肠道症状、电解质紊乱，以及心血管和呼吸系统不良事件。本部临床实践指导推荐特利加压素用于治疗肝硬化静脉曲张出血和肝肾综合征；但也指出，有待更多高质量的研究进一步探讨特利加压素对其他肝硬化相关并发症的疗效及安全性。
- 肝硬化 /
- 并发症 /
- 特利加压素 /
- 疾病管理 /
- 实践指导
Abstract: Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology of Chinese Medical Association and Hepatology Committee of Chinese Research Hospital Association have invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction, and bacterial infections and in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin-related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis related complications.
- Liver Cirrhosis /
- Complications /
- Terlipressin /
- Disease Management /
- Practice Guidance

HTML全文

表 1 特利加压素在肝硬化并发症中应用的指导声明

Table 1. Key guidance statements regarding the terlipressin in patients with liver cirrhosis

相关主题	条目序号	声明内容
食管胃静脉曲张出血	1	推荐特利加压素用于治疗肝硬化急性食管胃静脉曲张出血
	2	对于肝硬化急性消化道出血患者，若怀疑食管胃静脉曲张破裂是出血来源，则可在内镜检查前考虑使用特利加压素
	3	对于肝硬化急性消化道出血合并肾功能不全患者，可优先考虑使用特利加压素
肝肾综合征	4	推荐特利加压素用于1型肝肾综合征的治疗
腹水	5	对于肝硬化伴重度腹水或难治性腹水患者，若利尿剂无效或者无法耐受利尿剂相关不良反应，则可考虑使用特利加压素
腹腔穿刺大量(＞5 L)放腹水后循环功能障碍	6	推荐特利加压素用于预防肝硬化伴腹水患者腹腔穿刺大量(>5 L)放腹水后的循环功能障碍
细菌感染	7	对于肝硬化伴细菌性感染患者，可考虑使用特利加压素改善全身血流动力学状态、微循环和组织灌注
肝切除术	8	特利加压素可降低肝切除术中和术后门静脉压力，且有助于减少术中失血量和输血需求
肝移植术	9	特利加压素可用于改善肝移植术后全身血流动力学状态和肾功能
特利加压素相关不良反应	10	特利加压素引起的不良反应主要包括胃肠道反应、血电解质紊乱、心血管系统和呼吸系统不良事件等，常可通过减少剂量、停药或对症治疗后好转

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