Advances and challenges in cirrhosis and portal hypertension.
Advances and challenges in cirrhosis and portal hypertension.
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DOI：
10.1186/s12916-017-0966-6
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发表时间：
2017-11-10
期刊：
影响因子：
9.3
通讯作者：
Berzigotti A
中科院分区：
文献类型：
--
作者：
Berzigotti A
在西方国家，肝硬化是成人死亡的第四大原因，门静脉高压并发症是造成大多数伤亡的原因。为了降低死亡率，需要发展准确的诊断方法，早期诊断，有效的病因治疗，改进门静脉高压症的药物治疗，以及对终末期肝衰竭的有效治疗。肝硬化和门脉高压的早期检测现在可以使用简单的无创方法，从而在临床实践中推进个体化风险分层。尽管以前的假设，肝硬化可以回归，如果其病因被有效地消除。然而，虽然慢性丙型肝炎引起的肝硬化现在可以采用这种方法，但非酒精性脂肪性肝炎引起的肝硬化发病率急剧增加，而且还没有有效的治疗方法。新的药物作用于肝血管阻力的动态成分正在研究中，并有可能改善门静脉高压症的未来管理。肝硬化现在被视为一种动态疾病，能够在代偿期和失代偿期之间进展和倒退。这篇观点文章旨在提供作者对该领域当前主要进展和挑战的个人看法。
Liver cirrhosis is the fourth cause of death in adults in Western countries, with complications of portal hypertension being responsible for most casualties. In order to reduce mortality, development of accurate diagnostic methods for early diagnosis, effective etiologic treatment, improved pharmacological therapy for portal hypertension, and effective therapies for end-stage liver failure are required. Early detection of cirrhosis and portal hypertension is now possible using simple non-invasive methods, leading to the advancement of individualized risk stratification in clinical practice. Despite previous assumptions, cirrhosis can regress if its etiologic cause is effectively removed. Nevertheless, while this is now possible for cirrhosis caused by chronic hepatitis C, the incidence of cirrhosis due to non-alcoholic steatohepatitis has increased dramatically and effective therapies are not yet available. New drugs acting on the dynamic component of hepatic vascular resistance are being studied and will likely improve the future management of portal hypertension. Cirrhosis is now seen as a dynamic disease able to progress and regress between the compensated and decompensated stages. This opinion article aims to provide the author’s personal view of the current major advances and challenges in this field.
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