肝硬化门静脉高压与营养不良的关系
DOI: 10.3969/j.issn.1001-5256.2023.09.026
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:耿楠、孔明负责撰写文章;陈煜、段钟平负责审校。耿楠、孔明对本文贡献等同,同为第一作者。
-
摘要: 肝硬化的组织学结构异常常导致门静脉压力增加。门静脉高压是引发腹水、食管胃静脉曲张破裂出血、肝性脑病、肝肾综合征等肝硬化失代偿事件的主要原因。营养不良是肝硬化门静脉高压患者最常见的并发症之一。营养物质摄入减少、营养物质吸收障碍、高代谢、高氨血症和肠道菌群紊乱是导致肝硬化门静脉高压患者发生营养不良的主要原因。肝硬化门静脉高压与营养不良存在相互作用,本文就其相互影响方面的研究进展进行简要综述。Abstract: The abnormal histological structure of liver cirrhosis leads to the increase in portal venous pressure, and portal hypertension is the main cause of the decompensated events of liver cirrhosis such as ascites, gastroesophageal variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. Malnutrition is one of the most common complications in cirrhotic patients with portal hypertension, and the main causes of malnutrition include reduced nutrient intake, nutrient absorption disorders, hypermetabolism, hyperammonemia, and intestinal flora disturbance. There is an interaction between portal hypertension and malnutrition in liver cirrhosis, and this article briefly reviews the research advances in such interaction.
-
Key words:
- Liver Cirrhosis /
- Hypertension, Portal /
- Malnutrition /
- Sarcopenia /
- Frailty
-
[1] GINÈS P, KRAG A, ABRALDES JG, et al. Liver cirrhosis[J]. Lancet, 2021, 398( 10308): 1359- 1376. DOI: 10.1016/S0140-6736(21)01374-X. [2] LAI JC, TANDON P, BERNAL W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74( 3): 1611- 1644. DOI: 10.1002/hep.32049. [3] ENGELMANN C, CLÀRIA J, SZABO G, et al. Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction[J]. J Hepatol, 2021, 75( Suppl 1): S49-S66. DOI: 10.1016/j.jhep.2021.01.002. [4] MERLI M. Nutrition in cirrhosis: Dos and Don’ts[J]. J Hepatol, 2020, 73( 6): 1563- 1565. DOI: 10.1016/j.jhep.2020.07.019. [5] GLASS C, HIPSKIND P, TSIEN C, et al. Sarcopenia and a physiologically low respiratory quotient in patients with cirrhosis: a prospective controlled study[J]. J Appl Physiol(1985), 2013, 114( 5): 559- 565. DOI: 10.1152/japplphysiol.01042.2012. [6] TRAUB J, REISS L, ALIWA B, et al. Malnutrition in patients with liver cirrhosis[J]. Nutrients, 2021, 13( 2): 540. DOI: 10.3390/nu13020540. [7] YAO J, CHANG L, YUAN L, et al. Nutrition status and small intestinal bacterial overgrowth in patients with virus-related cirrhosis[J]. Asia Pac J Clin Nutr, 2016, 25( 2): 283- 291. DOI: 10.6133/apjcn.2016.25.2.06. [8] MÜLLER MJ, BÖTTCHER J, SELBERG O, et al. Hypermetabolism in clinically stable patients with liver cirrhosis[J]. Am J Clin Nutr, 1999, 69( 6): 1194- 1201. DOI: 10.1093/ajcn/69.6.1194. [9] LIU YY, CHEN DF, YAN QX. Current status of the pathogenesis, diagnosis, and treatment of sarcopenia in patients with liver cirrhosis[J]. J Clin Hepatol, 2022, 38( 1): 191- 195. DOI: 10.3969/j.issn.1001-5256.2022.01.033.刘钰懿, 陈东风, 颜綦先. 肝硬化肌少症的发病机制与诊疗现状[J]. 临床肝胆病杂志, 2022, 38( 1): 191- 195. DOI: 10.3969/j.issn.1001-5256.2022.01.033. [10] REN X, HAO S, YANG C, et al. Alterations of intestinal microbiota in liver cirrhosis with muscle wasting[J]. Nutrition, 2021, 83: 111081. DOI: 10.1016/j.nut.2020.111081. [11] TSIEN C, ANTONOVA L, SUCH J, et al. Impact of bacterial translocation on sarcopenia in patients with decompensated cirrhosis[J]. Nutrients, 2019, 11( 10): 2379. DOI: 10.3390/nu11102379. [12] TOPAN MM, SPOREA I, DĂNILĂ M, et al. Impact of sarcopenia on survival and clinical outcomes in patients with liver cirrhosis[J]. Front Nutr, 2021, 8: 766451. DOI: 10.3389/fnut.2021.766451. [13] DAJTI E, RENZULLI M, RAVAIOLI F, et al. The interplay between sarcopenia and portal hypertension predicts ascites and mortality in cirrhosis[J]. Dig Liver Dis, 2023, 55( 5): 637- 643. DOI: 10.1016/j.dld.2022.11.011. [14] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32( 2): 203- 219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32( 2): 203- 219. DOI: 10.3969/j.issn.1001-5256.2016.02.002. [15] TSAI MH, HUANG HC, PENG YS, et al. Nutrition risk assessment using the modified NUTRIC score in cirrhotic patients with acute gastroesophageal variceal bleeding: Prevalence of high nutrition risk and its independent prognostic value[J]. Nutrients, 2019, 11( 9): 2152. DOI: 10.3390/nu11092152. [16] WANG R, HUANG X, ZHOU T, et al. Safety and feasibility of early oral nutrition after endoscopic treatment for patients with liver cirrhosis: A historical prospective and comparative effectiveness study[J]. JPEN J Parenter Enteral Nutr, 2022, 46( 7): 1660- 1670. DOI: 10.1002/jpen.2328. [17] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. [18] BUSTAMANTE J, RIMOLA A, VENTURA PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis[J]. J Hepatol, 1999, 30( 5): 890- 895. DOI: 10.1016/s0168-8278(99)80144-5. [19] FALLAHZADEH MA, RAHIMI RS. Hepatic encephalopathy and nutrition influences: A narrative review[J]. Nutr Clin Pract, 2020, 35( 1): 36- 48. DOI: 10.1002/ncp.10458. [20] NARDELLI S, LATTANZI B, MERLI M, et al. Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis[J]. Hepatology, 2019, 70( 5): 1704- 1713. DOI: 10.1002/hep.30692. [21] TAPPER EB, KONERMAN M, MURPHY S, et al. Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index[J]. Am J Transplant, 2018, 18( 10): 2566- 2570. DOI: 10.1111/ajt.15020. [22] LAI JC, RAHIMI RS, VERNA EC, et al. Frailty associated with waitlist mortality independent of ascites and hepatic encephalopathy in a multicenter study[J]. Gastroenterology, 2019, 156( 6): 1675- 1682. DOI: 10.1053/j.gastro.2019.01.028. [23] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003. [24] SCHLEICHER EM, KREMER WM, KALAMPOKA V, et al. Frailty as tested by the clinical frailty scale is a risk factor for hepatorenal syndrome in patients with liver cirrhosis[J]. Clin Transl Gastroenterol, 2022, 13( 7): e00512. DOI: 10.14309/ctg.0000000000000512. [25] CHAPMAN B, GOW P, SINCLAIR M, et al. Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant[J]. JHEP Rep, 2019, 1( 2): 107- 113. DOI: 10.1016/j.jhepr.2019.05.002. -

计量
- 文章访问数: 705
- HTML全文浏览量: 153
- PDF下载量: 95
- 被引次数: 0