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了解肝硬化中的急性损伤:当前的观点
Sayan Malakar1, Sumit Rungta2, Arghya Samanta3
1Department of Gastroenterology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
World journal of hepatology
|June 12, 2025
概括
肝硬化患者的急性损伤 (AKI) 显著增加死亡率. 早期预测,检测和治疗AKI对于改善非补偿性肝硬化和急性至慢性肝衰竭 (ACLF) 的结果至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 肝病学 肝病学是一种肝病学.
- 内部医学 内部医学
背景情况:
- 急性损伤 (AKI) 影响了30-40%的住院肝硬化患者,严重的酒精性肝炎,自发性细菌性腹膜炎和急性慢性肝衰竭 (ACLF) 的发病率更高.
- 损伤是肝硬化的一个关键事件,与增加的死亡率密切相关.
- 病理生理因素包括全身血管扩张,心脏功能障碍,低 perfusion,内毒性,和直接的毒性.
研究的目的:
- 为病理生理学,诊断和AKI在肝硬化患者的管理中不断发展的概念提供全面的审查.
- 突出AKI早期检测和干预在高风险人群中的重要性.
主要方法:
- 本综述综合了关于肝硬化中AKI的机制和临床方面的当前文献.
- 专注于肝功能障碍,门高血压,全身炎症和血液动力学之间的相互作用.
主要成果:
- 肝硬化相关的AKI是由复杂的因素驱动的,包括肠道透性的改变,细菌转位,炎症级联和氨酸- ангиотензин- 阿尔多斯特系统的激活.
- 系统性血管扩张和有效血液体积的减少有助于血管收缩和AKI的发展.
- 感染和促炎性细胞因子在膜损伤中发挥着直接作用.
结论:
- 在患有不补偿性肝硬化和ACLF的患者中,由于相关的高死亡率,早期预测,检测和迅速治疗AKI至关重要.
- 了解复杂的病理生理学是开发AKI肝硬化治疗有效管理策略的关键.
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