肝硬化患者静脉曲张出血的预测
- Authors
- Arun J Sanyal, MD
Arun J Sanyal, MD
- Professor of Medicine
- Virginia Commonwealth University School of Medicine
- Jasmohan S Bajaj, MD
Jasmohan S Bajaj, MD
- Associate Professor of Medicine
- Virginia Commonwealth University and McGuire VA Medical Center
- Section Editor
- Bruce A Runyon, MD
Bruce A Runyon, MD
- Section Editor — Cirrhosis and Its Complications
- Clinical Professor of Medicine
- University of New Mexico, Division of Gastroenterology and Hepatology
- Special Hepatology Consultant to the Indian Health Service
- Northern Navajo Medical Center, Shiprock, New Mexico
- Deputy Editor
- Anne C Travis, MD, MSc, FACG, AGAF
Anne C Travis, MD, MSc, FACG, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 潘峻岩, 主任医师，教授
潘峻岩, 主任医师，教授
- 大连医科大学附属第一医院消化内科
引言
在北美洲，每1000个成年人中有3.6人患肝硬化，且肝硬化导致每年损失超过100万个工作日和32,000例死亡。肝硬化相关的并发症和死亡的主要原因是发生了静脉曲张出血，静脉曲张出血是门静脉高压症的直接后果[1]。每次活动性静脉曲张出血发作的相关死亡率为30%[2,3]。此外，一次活动性出血发作的幸存者在该次发作后1年内有70%的再出血风险[4]。
25%-40%的肝硬化患者会发生静脉曲张出血[5]。虽然有一些方法可用于预防首次静脉曲张出血的，但多数会伴有严重的不良反应。
准确识别出血风险最高患者才能进行分层，以试图避免对60%-75%永不会再发生静脉曲张出血的患者进行可能有害的预防性治疗。
本专题将总结静脉曲张的形成和进展，以及静脉曲张出血的预测因素和风险分类。肝硬化患者首次静脉曲张出血的预防和静脉曲张出血的治疗，以及静脉曲张再出血的预防将在别处讨论。 (参见“肝硬化患者静脉曲张出血的一级预防和零级预防”和“静脉曲张出血的一般治疗原则”和“肝硬化患者复发性静脉曲张出血的预防”)
静脉曲张的形成
门静脉压力取决于门静脉流入血量和门静脉流出阻力的乘积。门静脉高压症(定义为流体静压>5mmHg)最初由门静脉流出梗阻所致。梗阻可能发生于窦状隙前(门静脉血栓形成、门静脉纤维化或浸润性病变)、窦状隙(肝硬化)或窦状隙后(静脉闭塞性疾病、Budd Chiari综合征)水平。肝硬化是门静脉高压症的最常见原因；在这些肝硬化患者中，扭曲的肝窦所致的门静脉流出阻力的增加，以及内脏小动脉血管扩张导致的门静脉血流的增加导致了门静脉压升高。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2015-07-29.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010; 362:823.
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