研究动态
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代偿性肝硬化医疗管理的新方法。

Novel approaches in the medical management of compensated cirrhosis.

发表日期:2024 May 24
作者: Antonio Moreno-Loro, Álvaro Giráldez, Fernando Jiménez, Ignacio López-Bueno, Alberto Pérez-Ramírez, Manuel Romero-Gómez
来源: BIOMEDICINE & PHARMACOTHERAPY

摘要:

肝硬化的新颖治疗方法得到了肝硬化作为一种​​动态、系统性和可逆性疾病的既定范式的支持,与病因治疗的可用性密切相关。传统上,临床实践指南和专家建议侧重于失代偿性肝硬化患者的管理,因此我们将本次综述的重点放在改善对门诊随访的代偿期肝硬化患者的护理上。我们回顾了目前建立肝功能、诊断的方法晚期慢性肝病和有临床意义的门静脉高压症的治疗和治疗及其并发症的预防,特别关注隐性肝性脑病,我们还关注肝硬化的肝外并发症和姑息治疗。这一切都是从循证医学的角度出发,试图赋能精准医疗。 Pubmed 进行了文献检索,其中 MeSH 术语为“肝硬化”、“晚期慢性肝病”、“肝功能”、“门静脉高压”、“隐性肝性脑病”、“轻微肝性脑病”、“姑息治疗”。除了我们每六个月进行一次的肝功能计算和肝细胞癌影像筛查之外,我们还必须为肝硬化患者提供有偿的特殊护理和措施,以防止疾病进展及其并发症的出现。通常很少受到关注的实体,例如隐性肝性脑病或肝外并发症和肝硬化症状以及姑息治疗,必须受到关注。
Novel management of liver cirrhosis is supported by the well-established paradigm of liver cirrhosis as a dynamic, systemic, and reversible disease strongly related to the availability of etiological therapy. Classically, clinical practice guidelines and expert recommendations have focused on the management of decompensated cirrhotic patients, so we focused this review on improving care for compensated cirrhotic patients who are followed up in outpatient clinics.We reviewed the current methods for establishing liver function, the diagnosis and management of advanced chronic liver disease and clinically significant portal hypertension as well as the prevention of its complications, with special attention to covert hepatic encephalopathy, we also paid attention to the extrahepatic complications of cirrhosis and the palliative care. All this from the perspective of evidence-based medicine and trying to empower precision medicine. The literature search was undertaken by Pubmed with 'cirrhosis,' 'advanced chronic liver disease,' 'liver function,' 'portal hypertension,' 'covert hepatic encephalopathy,' 'minimal hepatic encephalopathy,' 'palliative care' as MeSH terms.We must offer compensated cirrhotic patients specific care and measures to prevent the progression of the disease and the appearance of its complications beyond the calculation of liver function and imaging screening for hepatocellular carcinoma that we perform every six months. Entities that have typically received little attention, such as covert hepatic encephalopathy or extrahepatic complications and symptoms of cirrhosis, and palliative care, must come to the spotlight.