肝硬化的诊断、分期及治疗原则

Clinical diagnosis,staging,and therapeutic principles of liver cirrhosis

近年来,随着对肝硬化的发病机制、病理生理、治疗和预后研究不断深入,国内外学者在诊断分期和治疗观念上有了很大变化。除了常用的代偿期和失代偿期二分法外,还可以根据腹水、食管胃静脉曲张出血及严重感染等表现分为五期。新的分期方法突出了不同阶段疾病的特点,为治疗提供了目标和依据。目前,病因治疗、针对关键发病机制和主要并发症的治疗,以及营养支持、运动指导及戒烟酒、改善口腔卫生等改善生活方式的综合治疗,是延缓疾病进展、改善预后的关键,而肝移植仍是治疗终末期肝硬化的最有效手段。

With in-depth studies on the pathogenesis,pathophysiology,treatment,and prognosis of liver cirrhosis in recent years,there have been great changes in staging and treatment concepts among scholars in China and globally.Besides the traditional staging system of compensated and decompensated liver cirrhosis,liver cirrhosis can be divided into five stages based on ascites,variceal bleeding,and severe infection,which highlights the features of this disease in different disease stages and this provides potential targets and basis for treatment.At present,the comprehensive management of liver cirrhosis,including etiological treatment,treatment targeting key pathogenesis and major complications,nutritional support,exercise guidance,and lifestyle adjustment(smoking cessation,alcohol withdrawal,and improvement of oral hygiene),is the key to delaying disease progression and improving prognosis,and liver transplantation remains the most effective approach for end-stage liver cirrhosis.