病因治疗对预后的影响。

StephenW

Hepatol Int. 2017 Jul 12. doi: 10.1007/s12072-017-9807-0. [Epub ahead of print]
Impact of etiological treatment on prognosis.Su CW1,2, Yang YY3,2, Lin HC4,5.
Author information
1Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.2Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.3Division of Clinical Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.4Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. [email protected].5Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. [email protected].

AbstractPortal hypertension (PHT) is a frequent and severe complication of cirrhosis. PHT may lead to the development of various complications with high mortality. Liver transplantation is the gold standard as a surgical curative treatment for end-stage liver disease. Theoretically, etiological treatment focusing on the pathophysiology of the underlying disease should be the objective of the nonsurgical management of cirrhotic PHT. Chronic viral hepatitis is the major etiology of cirrhosis and PHT. In cirrhotic patients with chronic hepatitis B virus infection, antiviral therapies can suppress viral replication, ameliorate hepatic inflammation, regress fibrosis, and restore liver functional reserve. Moreover, they can delay the progression of liver cirrhosis and ameliorate the severity of PHT. In patients with hepatitis C virus-induced liver cirrhosis, interferon and ribavirin combination therapy provide a favorable long-term prognosis, including lower rates of liver-related and non-liver-related deaths, hepatic decompensation, and hepatocellular carcinoma, particularly in those who have successful eradication of the virus after therapy. In patients with PHT, direct antivirals (DAAs) for hepatitis C virus infection have good safety profiles and excellent viral suppression. Moreover, DAAs can reduce hepatic venous pressure gradient. However, these effects are stronger during the earlier stage of liver cirrhosis. Abstinence is the cornerstone of etiological treatment for alcoholic liver disease. The effects of pharmacological treatments are not satisfactory, and additional studies are mandatory.


KEYWORDS: Alcoholic liver disease; Hepatitis B; Hepatitis C; Liver cirrhosis; Portal hypertension

PMID:28702738DOI:10.1007/s12072-017-9807-0

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StephenW

Hepatol Int。 2017年7月12日。doi：10.1007 / s12072-017-9807-0。 [提前印刷]
病因治疗对预后的影响。
Su CW1,2，Yang YY3,2，Lin HC4,5。
作者信息

1
    台北退伍军人总医院消化内科，肝病科，201，台北市士派路2号，台湾11217。
2
    台湾台北市国立阳明大学医学部医学系。
3
    台湾台北退伍军人总医院医学教育系临床培训处。
4
    台北退伍军人总医院消化内科，肝病科，201，台北市士派路2号，台湾11217。 [email protected]。
五
    台湾台北市国立阳明大学医学部医学系。 [email protected]。

抽象

门静脉高压（​​PHT）是肝硬化的常见且严重并发症。 PHT可能导致高死亡率的各种并发症的发展。肝移植是终末期肝病手术治疗的黄金标准。理论上，以病因为基础的病理生理学应该是肝硬化PHT非手术治疗的目的。慢性病毒性肝炎是肝硬化和PHT的主要病因。在慢性乙型肝炎病毒感染的肝硬化患者中，抗病毒治疗可以抑制病毒复制，改善肝脏炎症，退化纤维化，恢复肝功能储备。此外，它们可以延缓肝硬化的进展并改善PHT的严重程度。在丙型肝炎病毒诱导的肝硬化患者中，干扰素和利巴韦林联合治疗提供了有利的长期预后，包括肝脏相关和非肝相关死亡率，肝功能失代偿和肝细胞癌的发生率较低，特别是在那些治疗后成功根除病毒。在PHT患者中，丙型肝炎病毒感染的直接抗病毒药物（DAAs）具有良好的安全性和良好的病毒抑制作用。此外，DAAs可以减少肝静脉压力梯度。然而，在肝硬化早期阶段，这些作用更强。禁酒是酒精性肝病病因治疗的基石。药理治疗效果不理想，另外还有研究是强制性的。
关键词：

酒精性肝病;乙型肝炎丙型肝炎;肝硬化;门静脉高压

结论：
    28702738
DOI：
    10.1007 / s12072-017-9807-0