特利加压素在肝硬化并发症临床应用的实践指导(2021版)

Practice guidance for the use of terlipressin for liver cirrhosisrelated complications(2021)

肝硬化患病人数较多、死亡风险高,是全球疾病负担的重要组成部分之一。近年来,特利加压素在肝硬化相关并发症中的作用已逐渐得到认可。中华医学会消化病学分会肝胆疾病学组和中国研究型医院学会肝病专业委员会组织国内消化内科、肝病、感染性疾病、外科,以及临床药学领域的专家,在系统回顾当前循证医学证据的基础上,结合各位专家的临床经验,共制定了10条有关特利加压素在肝硬化并发症中临床应用的实践指导声明。特利加压素可使肝硬化伴急性静脉曲张出血或肝肾综合征患者获益,但在肝硬化伴腹水、穿刺后循环功能障碍、细菌感染,以及接受肝切除或肝移植术的患者中的应用证据仍不充分;此外,使用特利加压素时应密切监测不良事件的发生,主要包括胃肠道症状、电解质紊乱,以及心血管和呼吸系统不良事件。《特利加压素在肝硬化并发症临床应用的实践指导(2021版)》推荐特利加压素用于治疗肝硬化静脉曲张出血和肝肾综合征;但也指出,有待更多高质量的研究进一步探讨特利加压素对其他肝硬化相关并发症的疗效及安全性。

Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality.Role of terlipressin for the management of liver cirrhosis related complications has been recognized during recent years.This paper aims to develop evidencebased clinical practice guidance on the use of terlipressin for liver cirrhosis related complications.Hepatobiliary Study Group of Chinese Society of Gastroenterology of Chinese Medical Association and Hepatology Committee of Chinese Research Hospital Association have invited gastroenterologists,hepatologists,infectious disease specialists,surgeons,and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts′clinical experiences.Overall,10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis were proposed.Terlipressin can be beneficial for the management of cirrhotic patients with acute variceal bleeding and hepatorenal syndrome(HRS).However,the evidence regarding the use of terlipressin in cirrhotic patients with ascites,postparacentesis circulatory dysfunction,and bacterial infections and in those undergoing hepatic resection and liver transplantation remains insufficient.Terlipressinrelated adverse events,mainly including gastrointestinal symptoms,electrolyte disturbance,and cardiovascular and respiratory adverse events,should be closely monitored.The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis.Highquality studies are needed to further clarify its potential effects in other liver cirrhosis related complications.