2016年肝硬化领域基础与临床研究进展

Advances in basic and clinical research on liver cirrhosis in 2016

食管胃静脉曲张是肝硬化常见并发症，约见于50％肝硬化患者。食管胃静脉曲张出血的年发生率为5％～15％，即便应用了当前推荐的治疗方案，其6周内病死率仍高达15％～20％。自发性细菌性腹膜炎作为终末期肝脏疾病的一种常见的并发症，在重症肝损害患者中发生率为10％～30％。指无任何邻近组织炎症（如肠穿孔、肠脓肿）的情况下发生的腹膜和（或）腹水的细菌感染。肝性脑病是在慢性肝病背景下发生的以认知功能障碍为表现的临床综合征，其疾病的发病机制尚未完全阐明，和过去我们认识的引起肝性脑病发病与氨中毒学说、γ-氨基丁酸与内源性苯二氮革复合受体学说、炎症通路学说等机制有关。现对肝硬化上消化道出血处理、自发性细菌性腹膜炎、肝性脑病等方面2016年新进展进行介绍。

Esophageal and gastric varices are common complications of liver cirrhosis and are seen in 50% of patients with liver cirrhosis. The annual incidence rate of esophagogastric variceal bleeding is 5%- 15%, and even if the recommended treatment is used, the 6-week mortality rate is still as high as 15%-20%. Spontaneous bacterial peritonitis （SBP） is a common complication of end-stage liver disease and has an incidence rate of 10%-30% in patients with severe liver damage. SBP refers to the bacterial infection of the peritoneum and/or ascites that occurs in the absence of any inflammation in adjacent tissues （e.g., intestinal perforation and intestinal abscess）. Hepatic encephalopathy （HE） is the clinical syndrome manifesting as cognitive impairment in patients with chronic liver disease, and its pathogenesis has not yet been fully elucidated and may be associated with ammonia poisoning theory, y-aminobutyric acid and endogenous benzodiazepine complex receptor theory, and inflammatory pathway theory. This article introduces the advances in the treatment of upper gastrointestinal bleeding in patients with liver cirrhosis, SBP, and HE in 2016.