肝硬化患者的新治疗模式

StephenW

http://www.ncbi.nlm.nih.gov/pubmed/22729954
Hepatology. 2012 Nov;56(5):1983-92. doi: 10.1002/hep.25915.
New therapeutic paradigm for patients with cirrhosis.
Tsochatzis EA, Bosch J, Burroughs AK.
Source

Royal Free Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, UCL and Royal Free Hospital, London, UK.
Abstract

Cirrhosis is a major health problem, being the 5th cause of death in the U.K. and 12th in the U.S., but 4th in the 45 to 54 age group. Until recently cirrhosis was considered a single and terminal disease stage, with an inevitably poor prognosis. However, it is now clear that 1-year mortality can range from 1% in early cirrhosis to 57% in decompensated disease. As the only treatment for advanced cirrhosis is liver transplantation, what is urgently needed is strategies to prevent transition to decompensated stages. The evidence we present in this review clearly demonstrates that management of patients with cirrhosis should change from an expectant algorithm that treats complications as they occur, to preventing the advent of all complications while in the compensated phase. This requires maintaining patients in an asymptomatic phase and not significantly affecting their quality of life with minimal impairment due to the therapies themselves. This could be achieved with lifestyle changes and combinations of already licensed and low-cost drugs, similar to the paradigm of treating risk factors for cardiovascular disease. The drugs are propranolol, simvastatin, norfloxacin, and warfarin, which in combination would cost £128/patient annually-equivalent to U.S. $196/year. This treatment strategy requires randomized controlled trials to establish improvements in outcomes. In the 21st century, cirrhosis should be regarded as a potentially treatable disease with currently available and inexpensive therapies. (HEPATOLOGY 2012;56:1983-1992).

StephenW

肝硬化是一种严重的健康问题，是在英国第12和在美国第五的死亡原因，但是第
4在45岁至54岁年龄组。直到最近，肝硬化被认为是一个单一的终端疾病的阶段，一个不可避免的较差预后。然而，这是现在很清楚，1年死亡率的范围可以从早期肝硬化的1％至失代偿性疾病的57％。作为唯一的治疗晚期肝硬化是肝移植，是迫切需要的是战略，以防止过渡到失代偿阶段。在这篇评论中，我们提出的证据清楚地表明，肝硬化患者的管理应该从准算法，将并发症的发生，以防止所有并发症的出现，而在代偿期。这需要保持患者在无症状的阶段，并没有显着影响他们的生活质量以最小的损伤，由于自己的治疗。这可以实现与生活方式的改变和组合已经许可和低成本的药物，治疗心血管疾病的危险因素的范式类似。这些药物心得安，辛伐他汀，氟哌酸，以及华法林，在组合将花费£128/patient每年等值美元196/year。这种治疗策略的随机对照试验来确定改善的结果。在21世纪，肝硬化应该被视为一个潜在可治疗的疾病，目前已经上市，价格低廉的治疗。 （肝病学2012年56:1983-1992）。

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