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肝硬化难治性腹水的发病机制及临床管理的最新进展 [复制链接]

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发表于 2018-12-6 09:03 |只看该作者 |倒序浏览 |打印
An update on the pathogenesis and clinical management of cirrhosis with refractory ascites
Shuet Fong Neong, Danielle Adebayo & Florence Wong
Received 02 Aug 2018, Accepted 30 Nov 2018, Accepted author version posted online: 03 Dec 2018

    Download citation https://doi.org/10.1080/17474124.2018.1555469



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Abstract

Introduction: Ascites commonly complicates cirrhosis, becoming refractory to treatment with diuretics and sodium restriction in approximately 10% of patients. Pathogenesis of refractory ascites (RA) is multifactorial, the common final pathway being renal hypoperfusion and avid sodium retention. Refractory ascites has a negative prognostic implication in the natural history of cirrhosis. Management of RA include sodium restriction and regular large volume paracentesis (LVP) with albumin infusions, preventing paracentesis-induced circulatory dysfunction. In appropriate setting, transjugular intrahepatic porto-systemic shunt (TIPS) can be considered. Ascites clearance with TIPS can lead to nutritional improvement, avoiding sarcopenia. Liver transplantation (LT) remains the definitive treatment for eligible candidates.

Areas covered: Our review summarizes current updates on pathogenesis and clinical management of RA including potential future therapeutic options such as the automated slow-flow ascites pump, chronic outpatient albumin infusion and cell-free and concentrated ascites reinfusion therapy.

Expert commentary: Standard of care in patients with RA include LVP with albumin replacement and prompt referral for LT where indicated. Other novel therapeutic options on the horizon include automated low-flow ascites pump and cell-free, concentrated albumin reinfusion therapy.
Keywords: cirrhosis, Inflammation, Liver transplantation, Refractory ascites, TIPS, sodium retention

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发表于 2018-12-6 09:03 |只看该作者
肝硬化难治性腹水的发病机制及临床管理的最新进展
Shuet Fong Neong,Danielle Adebayo和Florence Wong
收稿日期2018年8月2日,接受2018年11月30日,接受作者版本发布于2018年12月03日

    下载引文https://doi.org/10.1080/17474124.2018.1555469



接受的作者版本
抽象

简介:腹水通常使肝硬化复杂化,大约10%的患者对利尿剂和钠限制治疗难以治愈。难治性腹水(RA)的发病机制是多因素的,常见的最终途径是肾脏低灌注和强烈的钠潴留。难治性腹水在肝硬化的自然史中具有阴性预后意义。 RA的管理包括钠限制和常规大容量腹腔穿刺(LVP)与白蛋白输注,防止腹腔穿刺引起的循环功能障碍。在适当的环境中,可以考虑经颈静脉肝内门体分流术(TIPS)。用TIPS清除腹水可以改善营养,避免肌肉减少症。肝移植(LT)仍然是合格候选人的最终治疗方法。

涵盖的领域:我们的综述总结了RA的发病机制和临床管理的最新更新,包括潜在的未来治疗选择,如自动慢流量腹水泵,慢性门诊白蛋白输注和无细胞和浓缩腹水再灌注治疗。

专家评论:RA患者的护理标准包括LVP和白蛋白替代,并在指示的情况下及时转诊LT。其他新的治疗选择包括自动低流量腹水泵和无细胞浓缩白蛋白再灌注治疗。
关键词:肝硬化,炎症,肝移植,难治性腹水,TIPS,钠潴留
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