慢性肝病相关门静脉高压的研究进展

摘要/Abstract

摘要： 不同类型的慢性肝病经过肝纤维化进展至肝硬化时往往表现出不同程度的门静脉高压,随着侧支循环的开放,侧支静脉的破裂出血威胁着患者的生命健康,临床上以食管静脉曲张破裂出血(EVB)较为多见。本文从作用机制、治疗方法及预后三方面,分别阐述不同类型慢性肝病出现门静脉高压的不同特征,旨在帮助临床医生提高对门静脉高压的认识。

关键词: 门静脉高压, 慢性肝病, 病毒性, 酒精性, 非酒精性, 原发性胆汁性胆管炎

桂绍强, 戴丛婷, 夏淑敏, 唐映梅. 慢性肝病相关门静脉高压的研究进展[J]. 肝脏, 2024, 29(6): 743-748.

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[1] Ginès P, Krag A, Abraldes J G, et al. Liver cirrhosis[J]. Lancet, 2021, 398(10308): 1359-1376.
[2] Seo Y S. Prevention and management of gastroesophageal varices[J]. Clin Mol Hepatol,2018, 24(1): 20.
[3] Garcia-Tsao G, Abraldes J G, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335.
[4] Reverter E, Tandon P, Augustin S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding[J]. Gastroenterology, 2014, 146(2): 412-419. e3.
[5] Fabbian F, Cappadona R, Guarino M, et al. Sex and acute oesophageal variceal bleeding-related in-hospital mortality: a 15-year retrospective study[J]. Eur Rev Med Pharmacol Sci, 2019, 23(2):811-817.
[6] Koh C, Heller T, Glenn J S. Pathogenesis of and new therapies for hepatitis D[J]. Gastroenterology, 2019, 156(2): 461-476. e1.
[7] Yuen M F, Chen D S, Dusheiko G M, et al. Hepatitis B virus infection[J]. Nat Rev Dis Primers, 2018, 4(1): 1-20.
[8] Iannacone M, Guidotti L G. Immunobiology and pathogenesis of hepatitis B virus infection[J]. Nat Rev Immunol, 2022, 22(1): 19-32.
[9] Zhang Y Y, Hu K Q. Rethinking the pathogenesis of hepatitis B virus (HBV) infection[J]. J Med Virol, 2015, 87(12): 1989-1999.
[10] Manns M P, Buti M, Gane E D, et al. Hepatitis C virus infection[J]. Nat Rev Dis Primers, 2017, 3(1): 1-19.
[11] Pisano M B, Giadans C G, Flichman D M, et al. Viral hepatitis update: progress and perspectives[J]. World J Gastroenterol, 2021, 27(26): 4018.
[12] Nguyen M H, Wong G, Gane E, et al. Hepatitis B virus: advances in prevention, diagnosis, and therapy[J]. Clin Microbiol Rev, 2020, 33(2): e00046-19.
[13] Suzuki F, Hosaka T, Suzuki Y, et al. Long-term outcome of entecavir treatment of nucleos (t) ide analogue-na?ve chronic hepatitis B patients in Japan[J]. J Gastroenterol, 2019, 54: 182-193.
[14] Yardeni D, Chang K M, Ghany M G. Current best practice in hepatitis B management and understanding long-term prospects for cure[J]. Gastroenterology, 2023, 164(1): 42-60. e6.
[15] Manns M P, Maasoumy B. Breakthroughs in hepatitis C research: from discovery to cure[J]. Nat Rev Gastroenterol Hepatol, 2022, 19(8): 533-550.
[16] Moon A M, Green P K, Rockey D C, et al. Hepatitis C eradication with direct-acting anti‐virals reduces the risk of variceal bleeding[J]. Aliment Pharmacol Ther, 2020, 51(3): 364-373.
[17] Urban S, Neumann-Haefelin C, Lampertico P. Hepatitis D virus in 2021: virology, immunology and new treatment approaches for a difficult-to-treat disease[J]. Gut, 2021, 70(9): 1782-1794.
[18] Koh C, Heller T, Glenn J S. Pathogenesis of and new therapies for hepatitis D[J]. Gastroenterology, 2019, 156(2): 461-476. e1.
[19] Lee H W, Park J Y, Kim S G, et al. Long-term outcomes of antiviral therapy in patients with advanced chronic HBV infection[J]. Clin Gastroenterol Hepatol, 2019, 17(13): 2811-2813. e1.
[20] Kumada T, Toyoda H, Yasuda S, et al. Long-term outcomes of viral eradication in patients with hepatitis C virus infection and mild hepatic fibrosis[J]. J Viral Hepat, 2021, 28(9): 1293-1303.
[21] Seitz H K, Bataller R, Cortez-Pinto H, et al. Alcoholic liver disease[J]. Nat Rev Dis Primers, 2018, 4(1): 16.
[22] Hyun J, Han J, Lee C, et al. Pathophysiological aspects of alcohol metabolism in the liver[J]. Int J Mol Sci, 2021, 22(11): 5717.
[23] Kim Y S, Kim S G. Endoplasmic reticulum stress and autophagy dysregulation in alcoholic and non-alcoholic liver diseases[J]. Clin Mol Hepatol, 2020, 26(4): 715-727.
[24] Bajaj J S. Alcohol, liver disease and the gut microbiota[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(4): 235-246.
[25] Tadokoro T, Morishita A, Himoto T, et al. Nutritional support for alcoholic liver disease[J]. Nutrients, 2023, 15(6): 1360.
[26] He Q, Yang C, Kang X, et al. Intake of Bifidobacterium lactis Probio-M8 fermented milk protects against alcoholic liver disease[J]. J Dairy Sci, 2022, 105(4): 2908-2921.
[27] Wang Q, Kim S Y, Matsushita H, et al. Oral administration of PEGylated TLR7 ligand ameliorates alcohol-associated liver disease via the induction of IL-22[J]. Proc Natl Acad Sci U S A, 2021, 118(1): e2020868118.
[28] Bennett K, Enki D G, Thursz M, et al. Systematic review with meta‐analysis: high mortality in patients with non-severe alcoholic hepatitis[J]. Aliment Pharmacol Ther, 2019, 50(3): 249-257.
[29] Penninti P, Adekunle A D, Singal A K. Alcoholic hepatitis: the rising epidemic[J]. Med Clin North Am, 2023, 107(3): 533-554.
[30] Gustot T, Jalan R. Acute-on-chronic liver failure in patients with alcohol-related liver disease[J]. J Hepatol, 2019, 70(2): 319-327.
[31] Eslam M, Sarin S K, Wong V W S, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease[J]. Hepatol Int, 2020, 14: 889-919.
[32] Powell E E, Wong V W S, Rinella M. Non-alcoholic fatty liver disease[J]. Lancet, 2021, 397(10290): 2212-2224.
[33] Park J, Zhao Y, Zhang F, et al. IL-6/STAT3 axis dictates the PNPLA3-mediated susceptibility to non-alcoholic fatty liver disease[J]. J Hepatol, 2023, 78(1): 45-56.
[34] Mitten E K, Baffy G. Mechanotransduction in the pathogenesis of non-alcoholic fatty liver disease[J]. J Hepatol, 2022, 77(6): 1642-1656.
[35] Kobayashi T, Iwaki M, Nakajima A, et al. Current research on the pathogenesis of NAFLD/NASH and the gut-liver axis: gut microbiota, dysbiosis, and leaky-gut syndrome[J]. Int J Mol Sci, 2022, 23(19): 11689.
[36] Ezpeleta M, Gabel K, Cienfuegos S, et al. Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: a randomized controlled trial[J]. Cell Metab, 2023, 35(1): 56-70. e3.
[37] Lei Y, Tang L, Chen Q, et al. Disulfiram ameliorates nonalcoholic steatohepatitis by modulating the gut microbiota and bile acid metabolism[J]. Nat Commun, 2022, 13(1): 6862.
[38] Targher G, Byrne C D, Tilg H. NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications[J]. Gut, 2020, 69(9): 1691-1705.
[39] Park J, Kim G, Kim H, et al. The association of hepatic steatosis and fibrosis with heart failure and mortality[J]. Cardiovasc Diabetol, 2021, 20(1): 197.
[40] Nakashima M, Nakamura K, Nishihara T, et al. Association between cardiovascular Disease and liver disease, from a clinically pragmatic perspective as a cardiologist[J]. Nutrients, 2023, 15(3): 748.
[41] Lleo A, Wang G Q, Gershwin M E, et al. Primary biliary cholangitis[J]. Lancet, 2020, 396(10266): 1915-1926.
[42] Li H, Guan Y, Han C, et al. The pathogenesis, models and therapeutic advances of primary biliary cholangitis[J]. Biomed Pharmacother, 2021, 140: 111754.
[43] Gulamhusein A F, Hirschfield G M. Primary biliary cholangitis: pathogenesis and therapeutic opportunities[J]. Nat Rev Gastroenterol Hepatol, 2020, 17(2): 93-110.
[44] Ezhilarasan D. Hepatic stellate cells in the injured liver: perspectives beyond hepatic fibrosis[J]. J Cell Physiol, 2022, 237(1): 436-449.
[45] Levy C, Manns M, Hirschfield G. New treatment paradigms in primary biliary cholangitis[J]. Clin Gastroenterol Hepatol, 2023, 21(8): 2076-2087.
[46] Perez C F M, Fisher H, Hiu S, et al. Greater transplant-free survival in patients receiving obeticholic acid for primary biliary cholangitis in a clinical trial setting compared to real-world external controls[J]. Gastroenterology, 2022, 163(6): 1630-1642. e3.
[47] John B V, Khakoo N S, Schwartz K B, et al. Ursodeoxycholic acid response is associated with reduced mortality in primary biliary cholangitis with compensated cirrhosis[J]. Am J Gastroenterol, 2021, 116(9): 1913-1923.
[48] John B V, Aitcheson G, Schwartz K B, et al. Male sex is associated with higher rates of liver‐related mortality in primary biliary cholangitis and cirrhosis[J]. Hepatology, 2021, 74(2): 879-891.

慢性肝病相关门静脉高压的研究进展

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