肝硬化預防性抗凝治療的臨床研究進展
發(fā)布時間：2018-11-07 08:52
【摘要】：背景:肝硬化(liver cirrhosis,LC)是一種常見并日益增長的全球性疾病及公共衛(wèi)生問題,年發(fā)病率約17/10萬。有報道稱其造成的全球死亡人口由1980年的676000增長到了2010年的1000000以上,占當年全世界所有死亡人口總數(shù)的2%。然而本病目前卻仍然缺乏特效治療,2015年日本胃腸病學會制定的《肝硬化循證醫(yī)學臨床實踐指南》中提出肝硬化現(xiàn)有的治療主要包括以下四個方面:營養(yǎng)支持治療、乙肝/丙肝抗病毒治療、抗纖維化治療及并發(fā)癥的治療,指南中也提及任何抗纖維化治療都是無效的,這導致肝硬化的治療非常棘手。肝硬化患者常伴有凝血功能障礙,傳統(tǒng)觀點認為處于低凝狀態(tài),有自發(fā)性出血風險,然而,近年越來越多的證據(jù)表明該類患者的血液可呈相對高凝狀態(tài),這種高凝狀態(tài)不僅參與調節(jié)肝纖維化及肝硬化的發(fā)生發(fā)展,也促進門靜脈血栓形成(portal vein thrombosis,PVT)。因此,有學者大膽推測預防性抗凝治療可能對預防PVT以及抗肝纖維化、延緩疾病進展有一定作用。目的:本文對近年國內外肝硬化的凝血系統(tǒng)變化以及預防性抗凝治療方面的相關文獻進行綜述,期望為肝硬化患者的抗纖維化治療提供新方向。方法:以“中文檢索詞:肝硬化、肝纖維化、高凝狀態(tài)、門靜脈血栓、預防性抗凝治療等;英文檢索詞:liver cirrhosis、liver fibrosis、hypercoagulability、portal vein thrombosis、prophylactic anticoagulation”檢索收錄于中國知網數(shù)據(jù)庫—CNKI、萬方數(shù)據(jù)知識服務平臺—WanFang、中國生物醫(yī)學文獻數(shù)據(jù)庫-CBM數(shù)據(jù)庫以及Pubmed數(shù)據(jù)庫中的關于肝硬化的凝血系統(tǒng)變化及預防性抗凝治療方面的相關文獻,對其進行分析及綜合評價。結果與結論:通過綜合分析大量文獻發(fā)現(xiàn),肝硬化機體通過多種代償機制可達到血液相對高凝狀態(tài);此種高凝狀態(tài)不僅參與調節(jié)肝纖維化和肝硬化的發(fā)生與發(fā)展,而且促進PVT的形成;多項臨床研究發(fā)現(xiàn)預防性抗凝治療可能對預防PVT及抗肝纖維化有一定作用,從而改善肝硬化患者的預后,提高總體生存率。因此,部分學者認為預防性抗凝治療有望成為肝硬化抗纖維化治療新方向。
[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.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2
[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.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2
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