• 1. 四川大學(xué)華西醫(yī)院老年科,成都,6100412. 峨眉山市中醫(yī)院內(nèi)科,峨眉山,614200;

肝硬化是多種肝臟疾病晚期的臨床病理過(guò)程,發(fā)病率高,嚴(yán)重影響患者的生活質(zhì)量.針對(duì)近期收治的1例肝硬化患者,我們進(jìn)行了循證醫(yī)學(xué)證據(jù)檢索和循證治療.結(jié)果發(fā)現(xiàn),對(duì)肝硬化患者的治療主要在于并發(fā)癥的處理,如對(duì)靜脈曲張出血的預(yù)防及治療,腹水的處理等.

引用本文： 舒德芬,梅 艷,董碧蓉. 1例肝硬化失代償期患者的循證治療. 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(4): 342-346. doi: 復(fù)制

1. Rambaldi A, Gluud C. Colchicine for alcoholic and non-alcoholic liver fibrosis and cirrhosis (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
2. Gentilini P, Bernardi M, Bolondi L, Craxi A, Gasbarrinie G, Ideo G, Laffi G, La Villa G, Salerno F, Ventura E, Pulazzini A, Segantini L, Romanelli RG. The rational use of albumin in patients with cirrhosis and ascites. A Delphi study for the attainment of a consensus on prescribing standards[J]. Dig Liver Dis, 2004; 36(8): 539-546.
3. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, Vargas V, Soriano G, Guevara M, Gines P, Rodes J. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. N Engl J Med, 1999; 341(6): 403-409.
4. Gines A, Fernandez-Esparrach G, Monescillo A, Vila C, Domenech E, Abecasis R, Angeli P, Ruiz-Del-Arbol L, Planas R, Sola R, Gines P, Terg R, Inglada L, Vaque P, Salerno F, Vargas V, Clemente G, Quer JC, Jimenez W, Arroyo V, Rodes J. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis[J]. Gastroenterology, 1996; 111(4): 1 002-1 010.
5. Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodes J. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J]. Gastroenterology, 2002; 123(6): 1 839-1 847.
6. Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, Nicolini A, Salvatori F. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J]. Hepatology, 2004; 40(3): 629-635.
7. Cheng JW, Zhu L, Gu MJ, Song ZM. Meta analysis of propranolol effects on gastrointestinal hemorrhage in cirrhotic patients[J]. World J Gastroenterol, 2003; 9(8): 1 836-1 839.
8. Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T. Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis[J]. Hepatology, 1997; 25(1): 63-70.
9. Patch D, Sabin CA, Goulis J, Gerunda G, Greenslade L, Merkel C, Burroughs AK. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis[J]. Gastroenterology, 2002; 123(4): 1 013-1 019.
10. Villanueva C, Minana J, Ortiz J, Gallego A, Soriano G, Torras X, Sainz S, Boadas J, Cusso X, Guarner C, Balanzo J. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding[J]. N Engl J Med, 2001; 345(9): 647-655.
11. Merkel C, Marin R, Enzo E, Donada C, Cavallarin G, Torboli P, Amodio P, Sebastianelli G, Sacerdoti D, Felder M, Mazzaro C, Beltrame P, Gatta A. Randomised trial of nadolol alone or with isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Gruppo-Triveneto per Lipertensione portale (GTIP)[J]. Lancet, 1996; 348(9 043): 1 677-1 681.
12. Garcia-Pagan JC, Morillas R, Banares R, Albillos A, Villanueva C, Vila C, Genesca J, Jimenez M, Rodriguez M, Calleja JL, Balanzo J, Garcia-Duran F, Planas R, Bosch J; Spanish Variceal Bleeding Study Group. Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: a double-blind RCT[J]. Hepatology, 2003; 37(6): 1 260-1 266.
13. Escorsell A, Bordas JM, del Arbol LR, Jaramillo JL, Planas R, Banares R, Albillos A, Bosch J. Randomized controlled trial of sclerotherapy versus somatostatin infusion in the prevention of early rebleeding following acute variceal hemorrhage in patients with cirrhosis. Variceal Bleeding Study Group[J]. J Hepatol, 1998; 29(5): 779-788.
14. Luca A, DAmico G, La Galla R, Midiri M, Morabito A, Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999; 212(2): 411-421.
15. Pomier-Layrargues G, Villeneuve JP, Deschenes M, Bui B, Perreault P, Fenyves D, Willems B, Marleau D, Bilodeau M, Lafortune M, Dufresne MP. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial[J]. Gut, 2001; 48(3): 390-396.
16. Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J. A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices[J]. Surg Endosc, 1999; 13(6): 580-584.
17. Djurdjevic D, Janosevic S, Dapcevic B, Vukcevic V, Djordjevic D, Svorcan P, Grgov S. Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial[J]. Endoscopy, 1999; 31(4): 286-290.
18. D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
19. Gross M, Schiemann U, Muhlhofer A, Zoller WG. Meta-analysis: efficacy of therapeutic regimens in ongoing variceal bleeding[J]. Endoscopy, 2001; 33(9): 737-746.
20. G(o/)tzsche PC. Somatostatin analogues for acute bleeding oesophageal varices (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
21. Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
22. Besson I, Ingrand P, Person B, Boutroux D, Heresbach D, Bernard P, Hochain P, Larricq J, Gourlaouen A, Ribard D, Kara NM, Legoux IL, Pillegand B, Becker MC, Costanzo J, Metreau JM, Silvain C and Beauchant M. Sclerotherapy with or without octreotide for acute variceal bleeding[J]. N Engl J Med, 1995; 333(9): 555-560.
23. Levacher S, Letoumelin P, Pateron D, Blaise M, Lapandry C, Pourriat JL. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients[J]. Lancet, 1995; 346(8 979): 865-868.
24. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis[J]. Hepatology, 1999; 29(6): 1 655-1 661.
25. Soares-Weiser K, Brezis M, Tur-Kaspa R, Paul M, Yahav J, Leibovici L. Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials[J]. Scand J Gastroenterol, 2003; 38(2): 193-200.
26. Singh N, Gayowski T, Yu VL, Wagener MM. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial[J]. Ann Intern Med, 1995; 122(8): 595-598.
27. Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C, Rossi Fanelli F, Abbiati R; Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial[J]. Gastroenterology, 2003; 124(7): 1 792-1 801.
28. Gerbes AL, Gulberg V, Gines P, Decaux G, Gross P, Gandjini H, Djian J; VPA Study Group. Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial[J]. Gastroenterology, 2003; 124(4): 933-939.
  1. 1. Rambaldi A, Gluud C. Colchicine for alcoholic and non-alcoholic liver fibrosis and cirrhosis (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  2. 2. Gentilini P, Bernardi M, Bolondi L, Craxi A, Gasbarrinie G, Ideo G, Laffi G, La Villa G, Salerno F, Ventura E, Pulazzini A, Segantini L, Romanelli RG. The rational use of albumin in patients with cirrhosis and ascites. A Delphi study for the attainment of a consensus on prescribing standards[J]. Dig Liver Dis, 2004; 36(8): 539-546.
  3. 3. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, Castells L, Vargas V, Soriano G, Guevara M, Gines P, Rodes J. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. N Engl J Med, 1999; 341(6): 403-409.
  4. 4. Gines A, Fernandez-Esparrach G, Monescillo A, Vila C, Domenech E, Abecasis R, Angeli P, Ruiz-Del-Arbol L, Planas R, Sola R, Gines P, Terg R, Inglada L, Vaque P, Salerno F, Vargas V, Clemente G, Quer JC, Jimenez W, Arroyo V, Rodes J. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis[J]. Gastroenterology, 1996; 111(4): 1 002-1 010.
  5. 5. Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodes J. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J]. Gastroenterology, 2002; 123(6): 1 839-1 847.
  6. 6. Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, Nicolini A, Salvatori F. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J]. Hepatology, 2004; 40(3): 629-635.
  7. 7. Cheng JW, Zhu L, Gu MJ, Song ZM. Meta analysis of propranolol effects on gastrointestinal hemorrhage in cirrhotic patients[J]. World J Gastroenterol, 2003; 9(8): 1 836-1 839.
  8. 8. Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T. Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis[J]. Hepatology, 1997; 25(1): 63-70.
  9. 9. Patch D, Sabin CA, Goulis J, Gerunda G, Greenslade L, Merkel C, Burroughs AK. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis[J]. Gastroenterology, 2002; 123(4): 1 013-1 019.
  10. 10. Villanueva C, Minana J, Ortiz J, Gallego A, Soriano G, Torras X, Sainz S, Boadas J, Cusso X, Guarner C, Balanzo J. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding[J]. N Engl J Med, 2001; 345(9): 647-655.
  11. 11. Merkel C, Marin R, Enzo E, Donada C, Cavallarin G, Torboli P, Amodio P, Sebastianelli G, Sacerdoti D, Felder M, Mazzaro C, Beltrame P, Gatta A. Randomised trial of nadolol alone or with isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Gruppo-Triveneto per Lipertensione portale (GTIP)[J]. Lancet, 1996; 348(9 043): 1 677-1 681.
  12. 12. Garcia-Pagan JC, Morillas R, Banares R, Albillos A, Villanueva C, Vila C, Genesca J, Jimenez M, Rodriguez M, Calleja JL, Balanzo J, Garcia-Duran F, Planas R, Bosch J; Spanish Variceal Bleeding Study Group. Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: a double-blind RCT[J]. Hepatology, 2003; 37(6): 1 260-1 266.
  13. 13. Escorsell A, Bordas JM, del Arbol LR, Jaramillo JL, Planas R, Banares R, Albillos A, Bosch J. Randomized controlled trial of sclerotherapy versus somatostatin infusion in the prevention of early rebleeding following acute variceal hemorrhage in patients with cirrhosis. Variceal Bleeding Study Group[J]. J Hepatol, 1998; 29(5): 779-788.
  14. 14. Luca A, DAmico G, La Galla R, Midiri M, Morabito A, Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials[J]. Radiology, 1999; 212(2): 411-421.
  15. 15. Pomier-Layrargues G, Villeneuve JP, Deschenes M, Bui B, Perreault P, Fenyves D, Willems B, Marleau D, Bilodeau M, Lafortune M, Dufresne MP. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial[J]. Gut, 2001; 48(3): 390-396.
  16. 16. Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J. A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices[J]. Surg Endosc, 1999; 13(6): 580-584.
  17. 17. Djurdjevic D, Janosevic S, Dapcevic B, Vukcevic V, Djordjevic D, Svorcan P, Grgov S. Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial[J]. Endoscopy, 1999; 31(4): 286-290.
  18. 18. D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  19. 19. Gross M, Schiemann U, Muhlhofer A, Zoller WG. Meta-analysis: efficacy of therapeutic regimens in ongoing variceal bleeding[J]. Endoscopy, 2001; 33(9): 737-746.
  20. 20. G(o/)tzsche PC. Somatostatin analogues for acute bleeding oesophageal varices (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  21. 21. Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  22. 22. Besson I, Ingrand P, Person B, Boutroux D, Heresbach D, Bernard P, Hochain P, Larricq J, Gourlaouen A, Ribard D, Kara NM, Legoux IL, Pillegand B, Becker MC, Costanzo J, Metreau JM, Silvain C and Beauchant M. Sclerotherapy with or without octreotide for acute variceal bleeding[J]. N Engl J Med, 1995; 333(9): 555-560.
  23. 23. Levacher S, Letoumelin P, Pateron D, Blaise M, Lapandry C, Pourriat JL. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients[J]. Lancet, 1995; 346(8 979): 865-868.
  24. 24. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis[J]. Hepatology, 1999; 29(6): 1 655-1 661.
  25. 25. Soares-Weiser K, Brezis M, Tur-Kaspa R, Paul M, Yahav J, Leibovici L. Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials[J]. Scand J Gastroenterol, 2003; 38(2): 193-200.
  26. 26. Singh N, Gayowski T, Yu VL, Wagener MM. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial[J]. Ann Intern Med, 1995; 122(8): 595-598.
  27. 27. Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C, Rossi Fanelli F, Abbiati R; Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial[J]. Gastroenterology, 2003; 124(7): 1 792-1 801.
  28. 28. Gerbes AL, Gulberg V, Gines P, Decaux G, Gross P, Gandjini H, Djian J; VPA Study Group. Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial[J]. Gastroenterology, 2003; 124(4): 933-939.