什么是肝硬化？症状，原因，诊断，治疗和预防

Cirrhosis is a condition in which the healthy tissue in the liver is replaced by nonliving scar tissue. Over time, the scar tissue inhibits the flow of blood through the liver and impairs the ability of the liver to process nutrients, hormones, and medication.

Cirrhosis is always related toother liver diseases并且经常因慢性肝炎而发展，alcohol-related liver disease（arld），或nonalcoholic fatty liver disease（（NAFLD). If cirrhosis goes untreated, the liver will not be able to function well andliver failuremay result.

Scarring, or fibrosis, in the liver occurs when it is exposed to toxic substances — such as alcohol or other drugs — or to inflammation, which can be caused by any liver disease, saysChristina Lindenmeyer, MD, a gastroenterologist at the Cleveland Clinic in Ohio.

Lindenmeyer博士说：“实际上有四个不同的疤痕阶段：F1（最小疤痕），F2（显着疤痕），F3（严重的纤维化）和F4（高级疤痕）。”她说，肝硬化是第4阶段，也是肝脏疤痕的最后阶段。

Lindenmeyer说，如果疤痕处于早期阶段，则不会出现肝硬化的症状。她说：“您可以患有正常肝功能的肝硬化”（这一阶段称为“补偿肝硬化”。“只有一旦肝脏代偿不足或停止做出工作，就会出现症状。”（（1)

Many people learn they have cirrhosis because of aCT scan对于另一种疾病。Lindenmeyer说：“在扫描之前，他们不知道自己患有肝病。”

随着时间的流逝，肝硬化可能开始引起症状，其中可能包括以下内容：

• Loss of appetite
• Fatigue
• 体重减轻或突然体重增加
• 皮肤发痒
• 一个brownish or orange color to the urine
• Light-colored stools
• Blood in the stool
• 发烧

以下是肝硬化的许多可能原因之一（2):

Chronic Viral Hepatitis B, C, or D慢性丙型肝炎c是美国肝硬化的主要原因。它导致肝脏肿胀，最终可能导致肝硬化。

大约四分之一people with hepatitis C发展肝硬化。虽然不太常见，但肝炎b和Dcan also cause cirrhosis.

Heavy Alcohol Use一个lcohol is toxic to the liver, and喝太多会导致肝脏发炎并肝细胞本身的变化。这会导致肿胀，并最终导致肝硬化。

Nonalcoholic Steatohepatitis (NASH)肝脏在肝脏中的脂肪与与酒精无关的脂肪被称为非酒精性脂肪肝病（NAFLD）。If NAFLD worsens, it can lead to NASH, which is when inflammation appears in the liver along with the fat.

Bile Duct DiseasesThese diseaseslimit or even prevent bile from flowing to the small intestine, which can cause swelling in the liver and lead to cirrhosis.

Family HistoryCertain genetic diseases can increase someone’s chances of developing cirrhosis.Wilson disease,血色素沉着病,glycogen storage diseases,alpha-1 antitrypsin deficiency, and自身免疫性肝炎are all genetic diseases that can cause cirrhosis.

了解有关酒精相关肝病的更多信息

肝硬化的初步检查包括完整的体检和症状的讨论，对人的病史和生活方式的审查以及blood tests。Liver function testscan measure levels of certain enzymes and proteins in the blood. If the levels are not within the normal range, it can indicate that the liver isn’t functioning properly. (2)

诊断肝硬化的黄金标准是活检Lindenmeyer说，为了确定疤痕的数量。一个活检involves removing a small piece of tissue from the liver for examination under a microscope.

But, according to Lindenmeyer, “a biopsy is fairly invasive and carries its own risk of potential adverse events, so we’ve actually developed a number of noninvasive ways to assess the amount of scarring.”

一个mong the noninvasive imaging tests available for diagnosing and monitoring liver disease are two, called shear wave elastography and transient elastography, that are based onultrasoundimaging technology. A third — magnetic resonance elastography — is based onMRItechnology. All of these tests measure the stiffness of the liver tissue, which indicates the severity of fibrosis, notes an article published on September 13, 2020, in the journalLife。（（3)

MRI或CT scancan also provide detailed images of the liver to help diagnose cirrhosis.

People with suspected cirrhosis may also have an上内窥镜检查，其中将带有相机连接的薄管通过嘴插入食道和胃中，以寻找静脉肿大（称为食管中的静脉曲张，胃中的胃病中称为静脉曲张）hypertension，或静脉中的高血压，将血液带到肝脏。（1）

Prognosis of Liver Cirrhosis

肝硬化的预期寿命取决于疾病的严重程度以及其根本原因。如果肝硬化被鉴定出来并尽早治疗，并且其进展停止，则可能对死亡率影响不大。

If cirrhosis is extensive before it is diagnosed or treated, or the person who has it continues to drink alcohol or use drugs that are toxic to the liver, the prognosis is less favorable.

根据美国肝病研究协会的2016年实践指南，肥胖症还与肝硬化的预后更差有关。（（4)

医生使用两个评分系统来预测肝硬化患者的死亡率：儿童 - 毒素-PUGH（CTP）评分和终末期肝病（MELD）分数的模型。两者都可以在未来三个月内估算一个人的死亡风险，并且可以使用CTP来估计一到两年的生存。

The MELD score was adopted by theUnited Network for Organ Sharing (UNOS)in 2002 to prioritize allocation of deceased donor organs for liver transplantation.

Whichever system is used by your doctor or hospital, if you have cirrhosis, your doctor should calculate your score at each visit to determine whether to refer you for a liver transplant evaluation. (5)

Cirrhosis is a progressive disease, which means it that gets worse over time. Liver damage cannot usually be reversed, but the injury can be stopped or slowed down with treatment or lifestyle changes.

治疗导致肝硬化的肝病的潜在类型是管理肝硬化的第一步，也是最重要的一步。防止进一步肝脏损害的其他健康习惯包括：（2）

• 遵循nutritious diet和practiceportion control。
• 避免酒精。
• Engage inregular exercise。
• Limit salt intake.
• 避免生贝类，该贝类可能包含细菌Vibrio vulnificus和make you very ill.
• Talk to your doctor about the medication you take and whether it might be contributing to your liver damage.
• Practicesafer sex。
• Don’t share needles, razors, or toothbrushes.
• Use clean needles for tattoos or piercings.

Lindenmeyer说，治疗肝硬化的第一步是避免对肝脏的侮辱。“如果自身免疫性肝炎是肝脏损害的根本原因，则治疗将治疗肝炎。对于酒精相关的肝病，治疗将始于避免酒精。代谢危险因素，例如超重或diabetes，将被解决以治疗NAFLD。为了血色素沉着病，治疗将降低铁超负荷的全身水平。” Lindenmeyer说。

The overall goal of the therapy is to stop the progression of the disease and prevent liver failure, she says.

药物选择

In addition to any medication that might be used to treat the underlying cause of cirrhosis, certain medications may be used to treat the complications that can result from it. (1)

为了example,乳糖可以针对肝性脑病开具处方，也可以是由于进入大脑的有毒物质引起的混乱。乳糖是一个laxativethat can help decrease the absorption of substances that can be harmful to the brain.

利尿剂， 或者水丸, may be prescribed to reduce ascites, or the accumulation of fluid in the abdomen.

一个ntibioticsmay be prescribed to prevent or treat infections.

Blood pressure medicinecan help lower pressure in the portal vein, which brings blood to the liver. Lowering pressure in the portal vein can, in turn, decrease the risk of internal bleeding and damage to the spleen.

Drugs that may be used to relieve itching associated with cirrhosis includecolestyramine和colesevelam这两者也用于降低血液cholesterol levels。如果这些药物无济于事或无法忍受，则这些药物rifampicin (also known as rifampin)或者naltrexonemay be tried, according to an article published in June 2015 inBritish Journal of General Practice。However, these drugs can have serious side effects affecting the liver and require close monitoring. (6)

Liver Transplantation

When medication can no longer control the complications of cirrhosis, a liver transplantation may be considered. (1)

一个liver transplant is a major operation in which a diseased liver is replaced with a whole, healthy liver from a deceased person or a partial, healthy liver from a living donor. However, there are many more people who need liver transplants than there are available organs. (7)

一个lternative and Complementary Therapies

There are a number of supplements on the market that claim to “cleanse”或“支持”肝脏健康。这些补品中的大多数没有科学证据来支持这些主张，有些则是显示包含有害成分。Those products that have been studied in clinical trials generally haven’t shown efficacy in those trials.

一个ccording to the Mayo Clinic, there currently isn’t enough evidence of benefit to recommend any herbal products to treat cirrhosis. (8)

One herbal remedy frequently mentioned in discussions of liver disease ismilk thistle, also known as silymarin. According to a review published online on February 17, 2020, in一个dvances in Therapy，研究中使用的三略胺蛋白的特殊配方已显示出对酒精或非酒精性脂肪肝病患者（包括肝硬化患者）具有积极作用。它还帮助那些drug-induced liver injuries。

The authors of the review state that “the mechanism of action by which silymarin produces these clinical effects is attributed to its antioxidant activity.” That being the case, they advise that its use be initiated as early in the disease course as possible, “when the regenerative potential of the liver is still high.” (9)

Keep in mind that the milk thistle products you find in retail stores are unlikely to be the same formulation as that used in clinical research studies.

由于某些草药疗法以及其他替代或补充疗法可能对肝脏有毒，请告诉您的医生您正在服用或有兴趣服用的任何产品。此外，在尝试任何形式的清洁或排毒方案之前，先与您的医生交谈。

RELATED:最受欢迎的排毒和清洁类型以及在尝试之前要知道什么

Prevention of Cirrhosis

有很多方法可以使肝脏保持健康并预防肝硬化，包括以下方法：（（10)

• Don’t drink alcohol to excess. If you consume alcohol, do it in moderation, which is up to one drink a day for women and up to two drinks a day for men, according to the Centers for Disease Control and Prevention (CDC). (11)
• 避免从事高风险的性行为，例如与多个伴侣进行无保护的性行为。
• 使用清洁产品，农药和其他化学物质时要谨慎。经常使用这些产品的人应在处理时穿防护服，包括手套和口罩。
• Getvaccinated for hepatitis B。
• 遵循healthy diet.
• Have regular medical checkups, and follow your doctor’s recommendations to control your weight, blood pressure,blood cholesterol, and blood sugar if you have diabetes.

门静脉高血压是肝硬化的并发症，可能在整个身体中产生负面影响。当疤痕组织的积聚阻塞血液流过肝脏时，会发生这种情况，导致门静脉中异常高血压，该静脉的血压异常，大静脉将血液从肠道传播到肝脏。反过来，这导致腹部流体的积累（称为腹水），食管或胃中的静脉出血，脾脏肿大。（（12)

肝硬化的其他并发症可能包括：

• 黄疸, a yellow discoloration of the skin and whites of eyes
• Bruising easily
• Edema， 或者fluid retention和swelling in the legs
• Hepatic encephalopathy, a buildup of toxins in the brain that causes confusion and, in advanced stages, coma
• 肾功能衰竭
• 多器官，非肝条件的问题，例如heart failure
• Liver cancer (most people who develop liver cancer have cirrhosis)

一个bout 1 out of every 10 people in the United States is affected by liver disease, though researchers believe that number may be higher, because many people with the condition may not be diagnosed. (2)

肝硬化在45至54岁之间的成年人中最常见，男性比女性更有可能患有肝硬化。（（13)

一个frican Americans and Hispanic Americans have a greater risk for developing liver disease than white Americans, and they are more likely to die of liver disease. A higher prevalence of risk factors, and disparities in rate and stage of diagnosis and care of liver disease all contribute to health inequity, according to a review in肝病学。（（14)

People with cirrhosis have an increased risk of liver cancer, and most (but not all) people who develop liver cancer have some evidence of cirrhosis.

In 2018, chronic liver disease was the ninth leading cause of death for Black Americans between ages 45 and 64, according to statistics collected by the CDC. (15)

一个frican American men are 60 percent more likely to have liver and IBD (intrahepatic bile duct) cancer that white men. African American women are 40 percent more likely to die from liver and IBD cancer than white women. (16)

Chronic liver disease is the seventh leading cause of deaths for all Hispanic Americans, and the fourth leading cause of death for Hispanic men ages 55 to 64. Both Hispanic men and women have a chronic liver disease rate that is twice that of white people. (17)

Hispanic men are 60 percent more likely to die of liver and IBD cancer than white men, and Hispanic women are 80 percent more likely to die from liver and IBD cancer than white women. (17)

2015年3月发表的评论酒精临床和实验研究酒精性肝病检查的频率,including alcoholic steatosis, hepatitis, and cirrhosis, in white, African American, and Hispanic individuals with alcoholic liver disease who were admitted or were followed as outpatients at University of California Davis Medical Center between 2002 and 2010.

研究人员发现，西班牙裔人比白人患者早4至10年患有这些疾病。在西班牙裔和白人中，患有严重酒精性肝炎的人比例相似，但在非洲裔美国人的加利福尼亚人中较低。（（18)

在这项研究中，与白人患者相比，西班牙裔患者更有可能肥胖，男性和糖尿病。

一个study in the一个rchives of Surgery发现与白人患者相比，黑人美国人和患有早期肝癌的西班牙裔更有可能死于疾病。诊断五年后，有18％的白肝癌患者还活着，相比之下，有15％的西班牙裔患者和12％的黑人患者。（（19)

Researchers found that Black and Hispanic patients were less likely to have surgery than white patients, and white patients underwent liver transplantation more frequently than any other racial or ethnic group. Even after adjusting forcancer stage和socioeconomic factors, the authors concluded that racial and ethnic disparities in survival were evident.

Given the many important functions of the liver in the body, it’s perhaps not surprising that a broad range of dysfunctions result when the liver is damaged and is not performing its normal tasks well, including filtering the blood and managing blood glucose levels.

Chronic Parkinsonism Associated With Cirrhosis

Parkinsonism— symptoms similar to those that occur in Parkinson’s disease — can develop in people with cirrhosis of the liver. The symptoms can include rapidly progressive hypokinesia (slowed or decreased movement), dystonia (involuntary muscle contractions), and rigidity. It is thought to result from the accumulation of manganese in certain part of the brain. (20)

Symptoms can sometimes improve with medication or a liver transplant.

Osteoporosis

Osteoporosisis commonly associated with chronic liver disease; a prevalence of as high as 55 percent has been reported in people with advanced liver cirrhosis. In a study reported in May 2018 in the journal药物，older age, lower body mass index (BMI), greater liver stiffness, and cirrhosis caused by alcoholic liver disease were associated with a higher骨质疏松症的风险。（（21)

Early diagnosis and management of both liver disease and osteoporosis are key to prevent fracture and further complications.

一个merican Association for the Study of Liver Diseases

这是一个专业的组织，适用于参与预防和治疗肝病的科学家和临床医生。该网站提供了诊断和治疗各种肝病的实践指南，以及有关组织的信息年度会议, which in 2020 was virtual and open to patients and patient advocates at a discounted rate.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

该政府组织参与研究，并向医生和患者提供最新信息。它的网站包括患者教育信息和诊断和实践工具treatment of liver disease。

一个merican Liver Foundation (ALF)

The American Liver Foundation is a not-for-profit organization that promotes education, advocacy, support services, and research for the prevention, treatment, and cure of liver disease. ALF has offices around the country and holds fundraising events to help fight liver disease.

像我这样的患者：肝肝硬化

这个网站让患者有机会分享寡糖r insights, symptoms, treatment information, and health outcomes, in addition to learning about the experiences of other people who share their condition.