欧洲失代偿期肝硬化并发症管理指南简介

正失代偿期肝硬化若发生并发症可进一步加速疾病的进展,这些并发症包括:出血、急性肾损伤(AKI)伴或不伴肝肾综合征(HRS)、肝肺综合征、门脉性肺动脉高压症、肝硬化性心肌病及细菌感染。事实上,细菌感染和肝细胞癌可发生在肝硬化的任何阶段,当然失代偿阶段更常见,这些并发症的出现将加速疾病的进展。最近,欧洲肝病学会(EASL)肝硬化专家组在准备更新腹水、自发性细菌性腹膜炎(SBP)和HRS诊疗指南时,率先     

饮食营养与糖尿病及其并发症研究进展

第64届美国糖尿病学会(ADA)年会上对饮食营养与糖尿病及其并发症的研究进展进行了交流。     

肝硬化少见并发症

肝功能多而复杂，肝硬化(失代偿期)可累及各个系统、器官。我院消化科自1998年以来共收治肝硬化患者603例，有13例患者出现临床少见并发症，其中痉挛性截瘫1例，胭静脉血栓形成1例，皮质盲3例，杵状指(趾)2例，阳痿5便，骨髓纤维化1例。现各举1例分析如下。     

肝硬化并发症治疗的某些进展

肝硬化并发症治疗的某些进展姚希贤（河北医学院附属二院内科石家庄０５００００）门脉高压上胃肠道出血、肝昏迷、大量腹水、功能性肾衰、癌变以及ＳＢＰ为肝硬化的常见并发症，有关治疗近年来取得一些进展。肝埂化上胃肠道出血肝硬化上胃肠道出血的原因包括：①曲张出血...     

健康教育对肝硬化患者并发症发生率的影响

肝硬化是一种常见的慢性肝病，为多种原因反复作用于肝脏而造成的弥漫性损害，晚期可出现严重并发症而危及生命。2001年1月～2002年1月．我们对69例肝硬化患者施行系统健康教育，旨在降低并发症的发生率，提高患者生活质量。现将结果报告如下。     

对2004年美国肝病学会关于肝硬化腹水治疗推荐意见的商榷

2004年美国肝病学会推荐了关于肝硬化腹水治疗意见（下称推荐意见）。笔者经反复阅读后认为,此推荐意见与我国研究近况相差甚大,有必要结合我国的研究情况进行学术争鸣、商榷与评价,以提高我们对肝硬化腹水的认识及治疗水平,现就以下问题提出商榷。     

肝硬化少见并发症的诊治

乳糜性及血性腹水、肝性胸水、少见病原菌感染的自发性腹膜炎、肝硬化心肌病、门静脉性肺动脉高压、肝硬化神经系统损伤等肝硬化少见并发症,临床医生尚缺乏充分的认识和/或及时有效的诊治。现介绍上述肝硬化少见并发症的临床特征、治疗及预后,以提高临床医生的认识和诊疗水平。     

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随着现代医学的发展,对疾病的诊断和治疗已经不再是临床医生的个人经验所决定的,而是要有经过正确评价的科学证据的支持.临床指南(clinical guideline)集中了新近最佳临床科学研究和专家意见,制订出对某一疾病的诊疗常规,为对于某一疾病诊断试验的应用和不同治疗手段的有效性提供明确清晰的推荐意见,可供世界各地医师应用.其通过降低临床实践的不一致性,减少不必要的诊断试验和防止采用无效的治疗手段,从而成为提高医疗质量的有用工具.     

糖代谢异常对肝硬化并发症的影响

目的 探讨糖代谢异常对肝硬化并发症的影响.方法 以2005年1月1日至2007年12月31日上海市第一人民医院消化内科494例肝硬化住院病例为研究对象,其中男293例,女201例,年龄(62±14)岁,回顾性分析糖代谢异常对肝硬化并发症的影响.计量资料比较采用t检验,计数资料采用卡方(X~2)检验,并计算比值比(OR值),P＜0.05为差异有统计学意义.结果 494例肝硬化中191例糖代谢异常,303例糖代谢正常.糖代谢异常者发生上消化道出血104/191例,脾功能亢进141/191例,高于糖代谢正常者的97/303例和194/303例,OR值分别是2.539和1.584,均P＜0.05.根据病毒性肝炎、嗜酒因素进行分层后,在无病毒性肝炎、不嗜酒的病例中,糖代谢异常发生上消化道出血和脾功能亢进的OR值分别是2.653和2.640,均P＜0.05.年龄分为＜50岁、50～70岁、＞70岁三组后,糖代谢异常均可增加肝硬化患者并发上消化道出血的发病危险性(OR值分别为3.314、2.233、2.425,均P＜0.01).结论 糖代谢异常是肝硬化患者发生上消化道出血和脾功能亢进的危险因素,且独立于病毒性肝炎和嗜酒.年龄分层后,糖代谢异常仍是肝硬化患者并发上消化道出血的危险因素.     

肝硬化性心肌病研究进展

肝硬化性心肌病是肝硬化的晚期并发症之一，国内研究报道较少，本综述近年来有关肝硬化性心肌病的研究进展。     

肝硬化的胃肠道并发症

肝硬化是慢性肝病的终末阶段,可影响到全身多器官功能。而肝硬化所致消化道损害临床上更为常见。肝硬化会导致胃肠动力下降、影响营养物质的消化吸收及破坏肠黏膜屏障功能,还会并发一系列胃肠道并发症,影响患者预后。临床上,更应重视肝硬化相关胃肠道并发症,做到早期监测、早期诊断和早期治疗,控制肝硬化病情进展、减少晚期并发症、提升患者生活质量。     

肝硬化的治疗进展

肝硬化是由各种因素导致慢性肝损害的一类晚期肝纤维化疾病。简述了肝硬化的病因及相关并发症的治疗进展,指出肝移植作为治疗肝硬化唯一有效的治疗手段,但却受到供肝及费用等问题限制,而干细胞具有治疗肝硬化的巨大潜力,成为研究热点,但其作用机制尚未明确,仍有很多问题尚未解决。     

Sodium in clinics and complications of liver cirrhosis

The changes in sodium homeostasis most frequently are expression of water-electrolyte balance disturbances in patients with liver cirrhosis. Hyponatremia of water excess is found in 35% of the patients with cirrhosis and ascites. This disturbance is most frequently connected with raised antidiuretic hormone (vasopressin) secretion and is realized by including of nonosmotic stimulating mechanisms. The vasopressin plays a leading role in pathogenesis of disturbed water metabolism in the liver cirrhosis. Some patients with hepatorenal syndrome are established with highest plasma vasopressin concentrations. Gene expression of the regulation of kidney vasopressin-sensitive water channels (aquaporin-2 proteins) is also raised in the liver cirrhosis. Using in practice vasopressin-type 2 (V-2) receptor antagonists gives hopeful results in medical treatment of water-electrolyte disturbances in patients with advanced liver cirrhosis.     

Usefulness of autotaxin for the complications of liver cirrhosis

BACKGROUND Autotaxin(ATX) has been reported as a direct biomarker for estimating the evaluation of liver fibrosis. But available data on ATX as a useful biomarker for the complications of liver cirrhosis(LC) are scant.AIM To assess the clinical usefulness of ATX for assessing the complications of LC.METHODS This multicenter, retrospective study was conducted at six locations in Japan. We include patients with LC, n = 400. The ATX level was evaluated separately in men and women because of its high level in female patients. To assess the clinical usefulness of ATX for the complications of LC, the area under the curve(AUC) of ATX assessing for the severe complications was analyzed in comparison with the model for end-stage liver disease score, albumin-bilirubin(ALBI) score, fibrosis-4 index, and aspartate aminotransferase-to-platelet ratio index.RESULTS The mean age was 68.4 ± 11.4 years, 240 patients(60.0%) were male. A total of 213(53.3%) and 187(46.8%) patients were compensated and decompensated,respectively. The numbers of patients with varix rupture, hepatic ascites, and hepatic encephalopathy were 35(8.8%), 131(32.8%), and 103(25.8%),respectively. The AUCs of ATX in men for hepatic encephalopathy, hepatic ascites, and varix ruptures were 0.853, 0.816, and 0.706, respectively. The AUCs of ATX in women for hepatic encephalopathy, hepatic ascites, and varix rupture were 0.759, 0.717, and 0.697, respectively. The AUCs of ATX in men were higher than those in women, as were all the other biomarkers used to detect encephalopathy and varix ruptures. However, for detecting ascites, the AUC of ALBI in men was more effective than using ATX.CONCLUSION ATX in men was more effective than any other biomarkers for detecting hepatic encephalopathy and varix ruptures.