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Updated: Jun 18, 2026

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预防先进的慢性肝病中的第一次和进一步的减补
Leonardo Corrêa Süffert1, Bernardo de Faria Moraes2, Guilherme Grossi Lopes Cançado3,4
1School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.
概括
预防晚期慢性肝病 (ACLD) 中的肝衰竭是关键. 卡维迪醇是一种非选择性β抑制剂,在预防脱补偿方面表现出优越性,并且在脱补偿的ACLD中更受欢迎.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 内部医学 内部医学
背景情况:
- 晚期慢性肝病 (ACLD) 显著导致全球发病率和死亡率.
- 肝衰竭,无论是初始的还是复发的,都是ACLD死亡的主要驱动因素.
- 从补偿到不补偿的ACLD的进展与临床显著的门高血压 (CSPH) 和诸如感染之类的诱发因素有关.
研究的目的:
- 概述驱动ACLD进展的病理生理机制.
- 讨论使用非侵入性测试进行风险分层.
- 在疾病各个阶段提出针对ACLD的务实预防策略.
主要方法:
- 对ACLD进展的病理生理机制的审查.
- 分析风险分层工具,包括非侵入性测试.
- 评估治疗策略以预防肝脏衰竭,包括药物治疗和内镜干预.
主要成果:
- 卡维迪洛尔是一种非选择性β阻断剂 (NSBB),与兰醇相比,在肝静脉压梯度 (HVPG) 中表现出优异的降低,有助于防止第一个失补偿.
- 虽然NSBB的疗效在去补偿性ACLD (dACLD) 中降低了,但卡维迪醇仍然是比普拉诺洛尔更喜欢的选择.
- 透视性水绑定 (EVL) 对于二次预防至关重要,也是NSBB不耐受患者的替代方案;在严重的dACLD中正在探索与卡维迪醇的联合治疗.
结论:
- 结合病因控制和血液动力学调节的多学科策略对于防止ACLD脱补偿至关重要.
- 卡维迪醇代表了一个优越的NSBB来预防第一个去补偿,是dACLD中首选的药物.
- 重新审视抗生素预防和优化营养,疫苗接种和身体活动是ACLD管理的重要组成部分.
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