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终末期肝病肠道并发症的研究进展
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Abstract:
终末期肝病是由于肝功能减退和门脉高压形成，易发生肠道并发症。而肠道功能障碍会引起明显的临床症状，甚至诱发一系列并发症。由于有些并发症起病隐匿、临床症状不典型，常延误诊治，严重影响患者生活质量及临床预后。本文针对终末期肝病肠道并发症的类型、流行病学特征、发病机制、病理生理、临床表现及诊断与治疗等多方面进行总结，以期在今后的临床工作中能更重视肠道并发症，做到积极预防，及时诊治，从而提高患者生活质量，改善预后。
End-stage liver disease is prone to intestinal complications due to hepatic decompensation and portal hypertension formation, and intestinal dysfunction will cause obvious clinical symptoms and even induce a series of complications. Due to its insidious onset and atypical clinical symptoms, di-agnosis and treatment are often delayed, seriously affecting patients’ quality of life and clinical prognosis. This paper summarizes the types, epidemiological characteristics, pathogenesis, patho-physiology, clinical manifestations, diagnosis and treatment of intestinal complications in end-stage liver disease, in order to pay more attention to intestinal complications in the future clinical work, so as to achieve proactive prevention, timely diagnosis and treatment, thus to improve the quality of life of patients and improve the prognosis.
| [1] | Wang, X., Liu, H., Qi, J., et al. (2023) Trends of Mortality in End-Stage Liver Disease—China, 2008-2020. China CDC Weekly, 5, 657-663. https://doi.org/10.46234/ccdcw2023.128 |
| [2] | Peng, J.K., Hepgul, N., Higginson, I.J., et al. (2019) Symptom Prevalence and Quality of Life of Patients with End-Stage Liver Disease: A Systematic Review and Meta-Analysis. Palliative Medicine, 33, 24-36.
https://doi.org/10.1177/0269216318807051 |
| [3] | 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. |
| [4] | Kalaitzakis, E. (2014) Gastrointestinal Dysfunction in Liver Cirrhosis. World Journal of Gastroenterology, 20, 14686-14695. https://doi.org/10.3748/wjg.v20.i40.14686 |
| [5] | Bloom, P.P., Rao, K., Bassis, C.M., et al. (2022) Duodenal Permeability Is Associated with Mucosal Microbiota in Compensated Cirrhosis. Clinical and Translational Gastroenterology, 13, e00522.
https://doi.org/10.14309/ctg.0000000000000522 |
| [6] | 陈美慧, 何兴祥, 蔡洁毅. 肝功能异常与小肠黏膜病变的研究进展[J]. 广东药学院学报, 2015, 31(4): 558-561. |
| [7] | Misra, V., Agrawal, R. and Misra, S.P. (2021) Portal Hy-pertensive Vasculopathy—An Entity Worth Remembering with Non-Neoplastic Gastrointestinal Lesions. Indian Journal of Pathology & Microbiology, 64, S32-S42.
https://doi.org/10.4103/ijpm.ijpm_201_21 |
| [8] | 徐京杭, 徐小元. 肝硬化“少见并发症”诊治现状和展望[J]. 中华肝脏病杂志, 2020, 28(5): 369-371. |
| [9] | 李姗姗, 杨长青. 门静脉高压性肠病——一种不该忽视的门静脉高压并发症[J]. 临床肝胆病杂志, 2022, 38(6): 1237-1241. |
| [10] | Tapper, E.B. and Parikh, N.D. (2023) Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA, 329, 1589-1602. https://doi.org/10.1001/jama.2023.5997 |
| [11] | 宋丹丹, 柴宁莉. 门脉高压性小肠病[J]. 中华胃肠内镜电子杂志, 2021, 8(1): 33-36. |
| [12] | Simbrunner, B., Mandorfer, M., Trauner, M., et al. (2019) Gut-Liver Axis Signaling in Portal Hypertension. World Journal of Gastroenterology, 25, 5897-5917. https://doi.org/10.3748/wjg.v25.i39.5897 |
| [13] | Sabat, N. and Schulze, B. (2023) Newly Diagnosed Cirrhosis Sec-ondary to Gastrointestinal Bleed Due to Portal Hypertensive Colopathy. Journal of Surgical Case Reports, 2023, rjad114. https://doi.org/10.1093/jscr/rjad114 |
| [14] | Mathur, V., Kaur, G., Prajapat, R.K., et al. (2021) Colonoscopic Findings in Patients of Portal Hypertension Due to Different Etiologies and their Correlation. The Journal of the Association of Physicians of India, 69, 11-12. |
| [15] | Demetiou, G., Augoustaki, A. and Kalaitzakis, E. (2022) Endoscopic Management and Outcome of Non-Variceal Bleeding in Patients with Liver Cirrhosis: A Systematic Review. World Journal of Gas-trointestinal Endoscopy, 14, 163-175. https://doi.org/10.4253/wjge.v14.i3.163 |
| [16] | Rockey, D.C. (2019) An Up-date: Portal Hypertensive Gastropathy and Colopathy. Clinical Liver Disease, 23, 643-658.
https://doi.org/10.1016/j.cld.2019.07.002 |
| [17] | Ahn, S.S., Kim, E.H., Kim, M.D., et al. (2015) Successful Hemo-stasis of Intractable Rectal Variceal Bleeding Using Variceal Embolization. World Journal of Gastroenterology, 21, 2558-2562. https://doi.org/10.3748/wjg.v21.i8.2558 |
| [18] | Anand, R., Ali, S.E., Raissi, D., et al. (2019) Duodenal Variceal Bleeding with Large Spontaneous Portosystemic Shunt Treated with Transjugular Intrahepatic Portosystemic Shunt and Embolization: A Case Report. World Journal of Radiology, 11, 110-115. https://doi.org/10.4329/wjr.v11.i8.110 |
| [19] | Li, W., Wang, J., Fu, H., et al. (2022) Isolated Sigmoid Varicose Vein Rupture and Hemorrhage: A Case Report. Medicine (Baltimore), 101, e30024. https://doi.org/10.1097/MD.0000000000030024 |
| [20] | Then, E., Lund, C., Uhlenhopp, D.J., et al. (2020) Cirrhosis Is Associated with Worse Outcomes in Ischemic Colitis: A Nationwide Retrospective Study. Gastroenterology Research, 13, 253-259. https://doi.org/10.14740/gr1339 |
| [21] | Tranah, T.H., Nayagam, J.S., Gregory, S., et al. (2023) Diagno-sis and Management of Ectopic Varices in Portal Hypertension. The Lancet Gastroenterology & Hepatology, 8, 1046-1056.
https://doi.org/10.1016/S2468-1253(23)00209-1 |
| [22] | Sotiropoulos, C., Sakka, E., Diamantopoulou, G., et al. (2022) Combination of Percutaneous Transhepatic Balloon-Assisted Transjugular Intrahepatic Collateral Caval Shunt and Embolization for Successful Hemostasis of Lower Gastrointestinal Bleeding Associated with Extremely Enlarged Ano-rectal Varicose Veins. Cureus, 14, e21053.
https://doi.org/10.7759/cureus.21053 |
| [23] | Hori, A., Watanabe, Y., Takahashi, K., et al. (2022) A Rare Case of Duodenal Variceal Bleeding Due to Extrahepatic Portal Vein Obstruction Successfully Treated with Endoscopic Injection Sclerotherapy. Clinical Journal of Gastroenterology, 15, 617-622. https://doi.org/10.1007/s12328-022-01627-3 |
| [24] | Zhigalova, S.B., Shertsinger, A.G., Manukyan, G.V., et al. (2022) Ectopic Duodenal Varices as a Cause of Difficult Diagnosis of Bleeding in Extrahepatic Portal Hypertension. Khirurgiia, No. 8, 106-109.
https://doi.org/10.17116/hirurgia2022081106 |
| [25] | Jansson-Knodell, C.L., Calderon, G., Weber, R., et al. (2021) Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Lit-erature Review. The American Journal of Gastroenterology, 116, 1426-1436. https://doi.org/10.14309/ajg.0000000000001204 |
| [26] | Feng, X., Li, X., Zhang, X., et al. (2022) Hepatic Encepha-lopathy in Cirrhotic Patients and Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis. BioMed Research International, 2022, Article ID: 2469513. https://doi.org/10.1155/2022/2469513 |
| [27] | Gundling, F., Luxi, M., Seidel, H., et al. (2021) Small Intestinal Dysmotility in Cirrhotic Patients: Correlation with Severity of Liver Disease and Cirrhosis-Associated Complications. Zeitschrift für Gastroenterologie, 59, 540-550.
https://doi.org/10.1055/a-1162-0357 |
| [28] | Gudan, A., Jamio？-Milc, D., Hawry？kowicz, V., et al. (2022) The Preva-lence of Small Intestinal Bacterial Overgrowth in Patients with Non-Alcoholic Liver Diseases: NAFLD, NASH, Fibrosis, Cirrhosis—A Systematic Review, Meta-Analysis and Meta-Regression. Nutrients, 14, Article No. 5261. https://doi.org/10.3390/nu14245261 |
| [29] | Pijls, K.E., Jonkers, D.M., Elamin, E.E., et al. (2013) Intestinal Epithelial Barrier Function in Liver Cirrhosis: An Extensive Review of the Literature. Liver International, 33, 1457-1469. https://doi.org/10.1111/liv.12271 |
| [30] | Souza, C., Rocha, R. and Cotrim, H.P. (2022) Diet and Intestinal Bacterial Overgrowth: Is There Evidence? World Journal of Clinical Cases, 10, 4713-4716. https://doi.org/10.12998/wjcc.v10.i15.4713 |
| [31] | Richard, N., Desprez, C., Wuestenberghs, F., et al. (2021) The Effectiveness of Rotating versus Single Course Antibiotics for Small Intestinal Bacterial Overgrowth. United European Gastroenterology Journal, 9, 645-654.
https://doi.org/10.1002/ueg2.12116 |
| [32] | 牛国超, 孙东磊, 张晓岚. 小肠细菌过度生长对肝硬化的影响及其治疗对策[J]. 临床肝胆病杂志, 2022, 38(9): 2146-2149. |
| [33] | Shi, H., Mao, L., Wang, L., et al. (2021) Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Patients of Nonalcoholic Fatty Liver Disease. European Journal of Gastroenterology & Hepatology, 33, e535-e539.
https://doi.org/10.1097/MEG.0000000000002157 |
| [34] | Fukui, H. (2021) Leaky Gut and Gut-Liver Axis in Liver Cirrhosis: Clinical Studies Update. Gut and Liver, 15, 666-676. https://doi.org/10.5009/gnl20032 |
| [35] | Senzolo, M., Riva, N., Dentali, F., et al. (2018) Long-Term Outcome of Splanchnic Vein Thrombosis in Cirrhosis. Clinical and Translational Gastroenterology, 9, e176. https://doi.org/10.1038/s41424-018-0043-2 |
| [36] | Wang, L., Xu, X., Hou, Y., et al. (2019) Acute Mesenteric Vein Thrombosis after Endoscopic Injection Sclerotherapy for Esophageal Varices in a Patient with Liver Cirrhosis. Drug Discoveries & Therapeutics, 13, 118-121.
https://doi.org/10.5582/ddt.2019.01014 |
| [37] | Wang, L., Guo, X., Bai, Z., et al. (2022) Impact of Asymptomatic Su-perior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis. Thrombosis and Haemostasis, 122, 2019-2029.
https://doi.org/10.1055/s-0042-1756648 |
