肝硬化预防性抗凝治疗的临床研究进展

发布时间：2018-11-07 08:52

【摘要】：背景:肝硬化(liver cirrhosis,LC)是一种常见并日益增长的全球性疾病及公共卫生问题,年发病率约17/10万。有报道称其造成的全球死亡人口由1980年的676000增长到了2010年的1000000以上,占当年全世界所有死亡人口总数的2%。然而本病目前却仍然缺乏特效治疗,2015年日本胃肠病学会制定的《肝硬化循证医学临床实践指南》中提出肝硬化现有的治疗主要包括以下四个方面:营养支持治疗、乙肝/丙肝抗病毒治疗、抗纤维化治疗及并发症的治疗,指南中也提及任何抗纤维化治疗都是无效的,这导致肝硬化的治疗非常棘手。肝硬化患者常伴有凝血功能障碍,传统观点认为处于低凝状态,有自发性出血风险,然而,近年越来越多的证据表明该类患者的血液可呈相对高凝状态,这种高凝状态不仅参与调节肝纤维化及肝硬化的发生发展,也促进门静脉血栓形成(portal vein thrombosis,PVT)。因此,有学者大胆推测预防性抗凝治疗可能对预防PVT以及抗肝纤维化、延缓疾病进展有一定作用。目的:本文对近年国内外肝硬化的凝血系统变化以及预防性抗凝治疗方面的相关文献进行综述,期望为肝硬化患者的抗纤维化治疗提供新方向。方法:以“中文检索词:肝硬化、肝纤维化、高凝状态、门静脉血栓、预防性抗凝治疗等;英文检索词:liver cirrhosis、liver fibrosis、hypercoagulability、portal vein thrombosis、prophylactic anticoagulation”检索收录于中国知网数据库—CNKI、万方数据知识服务平台—WanFang、中国生物医学文献数据库-CBM数据库以及Pubmed数据库中的关于肝硬化的凝血系统变化及预防性抗凝治疗方面的相关文献,对其进行分析及综合评价。结果与结论:通过综合分析大量文献发现,肝硬化机体通过多种代偿机制可达到血液相对高凝状态;此种高凝状态不仅参与调节肝纤维化和肝硬化的发生与发展,而且促进PVT的形成;多项临床研究发现预防性抗凝治疗可能对预防PVT及抗肝纤维化有一定作用,从而改善肝硬化患者的预后,提高总体生存率。因此,部分学者认为预防性抗凝治疗有望成为肝硬化抗纤维化治疗新方向。
[Abstract]:Background: cirrhosis of the liver (liver cirrhosis,LC) is a common and growing global disease and public health problems, the annual incidence of about 17 / 100,000. Reports say the number of deaths worldwide rose from 676000 in 1980 to more than 1000000 in 2010, accounting for 2 percent of all deaths worldwide that year. However, there is still a lack of effective treatment for this disease. In the "guidelines for Clinical practice of Evidence-based Medicine for liver Cirrhosis" formulated by the Japanese Gastroenterology Society in 2015, it is proposed that the current treatment of liver cirrhosis mainly includes the following four aspects: nutrition support therapy. Hepatitis B / C antiviral treatment, antifibrosis treatment and treatment of complications, the guidelines also mention that any anti-fibrosis treatment is ineffective, which makes the treatment of liver cirrhosis very difficult. Cirrhotic patients are often associated with coagulation dysfunction, and the traditional view is that they are in a low coagulation state and have a risk of spontaneous bleeding. However, in recent years, more and more evidence has shown that the blood of this group of patients can be relatively hypercoagulable. This hypercoagulable state not only regulates the development of hepatic fibrosis and cirrhosis, but also promotes portal vein thrombosis (portal vein thrombosis,PVT). Therefore, some scholars speculate that prophylactic anticoagulant therapy may play a role in preventing PVT and preventing liver fibrosis and delaying the progress of disease. Objective: to review the changes of coagulation system and preventive anticoagulant therapy in cirrhotic patients in recent years, in order to provide a new direction for anti-fibrosis treatment in cirrhotic patients. Methods: Chinese key words: cirrhosis, hepatic fibrosis, hypercoagulability, portal vein thrombosis, preventive anticoagulant therapy, etc. English search term: liver cirrhosis,liver fibrosis,hypercoagulability,portal vein thrombosis,prophylactic anticoagulation "Retrieval in China knowledge Web Database-CNKI, Wanfang data knowledge Service platform-WanFang, The Chinese biomedical literature database-CBM database and Pubmed database on the changes of coagulation system and preventive anticoagulant therapy in liver cirrhosis were analyzed and evaluated. Results and conclusion: through the comprehensive analysis of a large number of literatures, it is found that the liver cirrhosis body can reach the state of relative hypercoagulability through various compensatory mechanisms. The hypercoagulable state not only regulates the occurrence and development of liver fibrosis and cirrhosis, but also promotes the formation of PVT. Many clinical studies have found that prophylactic anticoagulant therapy may play a role in preventing PVT and anti-hepatic fibrosis, thus improving the prognosis of patients with liver cirrhosis and improving the overall survival rate. Therefore, some scholars believe that prophylactic anticoagulant therapy may become a new direction of anti-fibrosis therapy for liver cirrhosis.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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