患有非酒精性脂肪肝疾病的患者的门性高血压:当前的知识和挑战
Anita Madir1, Ivica Grgurevic1,2,3, Emmanuel A Tsochatzis4
1Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb 10000, Croatia.
在非酒精性脂肪性肝病 (NAFLD) 中,门性高血压可能由于脂质积累而早期发生,而不仅仅是纤维化. 当前的诊断方法可能低估了压力,需要新的方法来准确评估风险.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 病理生理学 病理生理学
背景情况:
- 门性高血压 (PH) 传统上与非酒精性脂肪肝疾病 (NAFLD) 中的晚期纤维化有关.
- 新出现的证据表明,PH可以通过纤维化以外的机制在早期的NAFLD阶段发展.
- 肝细胞脂质的积累和气球运动有助于鼻状压缩和早期PH.
研究的目的:
- 探索非酒精性脂肪肝疾病中门高血压的早期病原遗传机制.
- 解决目前诊断方法在NAFLD中准确评估门口压力的局限性.
- 确定可靠的方法,用于预后风险分层在NAFLD患者的门性高血压.
主要方法:
- 关于NAFLD病变和门高血压的最新研究的综述.
- 分析肝叶片中的组织学和功能变化.
- 评估包括肝静脉压梯度 (HVPG) 和非侵入性标记物在内的诊断方法.
主要成果:
- 在NAFLD早期的PH与肝细胞脂质积累,气球和侧侧压缩有关.
- 机械力激活的机械传导通路有助于内皮功能障碍和纤维化.
- 像HVPG这样的当前方法可能会低估NAFLD的门口压力,可能缺失临床显著的门口高血压 (CSPH).
结论:
- 与NAFLD相关的PH涉及纤维化以外的机制,包括脂质积累和机械应激.
- 由于当前方法的局限性,准确的诊断和NAFLDPH风险分层是具有挑战性的.
- 非侵入性方法,如肝脏/脏硬和血小板计数显示出诊断CSPH的希望;生活方式的改变和代谢综合征管理是关键的治疗方法.
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