Consensus interpretation of Baveno Ⅶ in the diagnosis and treatment of portal hypertension in cirrhosis: a physician's perspective
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摘要: 门静脉高压是影响肝硬化预后的重要因素，评估门静脉压力并合理管理是肝硬化门静脉高压及其并发症的重要诊治内容。2021年的新版肝硬化门静脉高压Baveno Ⅶ共识意见进一步更新与丰富门静脉高压的诊断与治疗内容，并强调个体化分层管理与治疗。本文主要围绕门静脉高压的非创诊断、药物预防与治疗等，重点解读Baveno Ⅶ共识意见内科相关研究进展。Abstract: Portal hypertension is an important pathophysiological factor affecting the prognosis of cirrhotic patients. Evaluating portal pressure and proper management are important strategies for the patients with cirrhotic portal hypertension. The 2021 edition of the Baveno Ⅶ Consensus on portal hypertension in cirrhosis updated the diagnosis and treatment with an emphasis on individualized, stratified management and treatment. The current article will focuse on interpreting the latest research progress in internal medicine from the aspects of non-invasive diagnosis, hierarchical management, drug prevention and treatment of portal hypertension.
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Key words:
- liver cirrhosis /
- portal hypertension /
- diagnosis /
- treatment /
- internal medicine
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表 1 不同类型门静脉高压的压力表现特点
类型 WHVP FHVP HVPG 肝前性 正常 正常 正常 肝内性 窦前性 正常 正常 正常 窦性 ↑ 正常 ↑ 窦后性 ↑ 正常 ↑ 肝后性 心衰 ↑ ↑ 正常 布加综合征 测量困难 测量困难 测量困难 
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表 2 常用无创方法对cACLD及其CSPH的评价应用
非侵入性指标 排除cACLD 早期代偿期cACLD 晚期代偿期cACLD LSM/kPa < 10，无明显表现 10~15 15~20 20~25 ≥25 PLT/(×109·L-1) 任何 ≥150 < 110 < 150 任何 HVPG/mmHg ≤5 5~10 ≥10 ≥10 ≥10 CSPH 无 无 60%风险 60%风险 确认 SSM/kPa < 21 < 21 > 50 > 50 > 50
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表 3 历届Baveno共识推荐降门静脉高压药物一览表
Baveno Ⅰ BavenoⅡ Baveno Ⅲ Baveno Ⅳ Baveno Ⅴ Baveno Ⅵ Baveno Ⅶ NSBB 普萘洛尔
纳多洛尔普萘洛尔
纳多洛尔普萘洛尔
纳多洛尔普萘洛尔
纳多洛尔普萘洛尔
纳多洛尔
卡维地洛普萘洛尔
纳多洛尔
卡维地洛普萘洛尔
纳多洛尔
卡维地洛血管活性药 特利加压素
生长抑素特利加压素
生长抑素特利加压素
生长抑素
奥曲肽特利加压素
生长抑素
奥曲肽
伐普肽特利加压素
生长抑素
奥曲肽
伐普肽特利加压素
生长抑素
奥曲肽特利加压素
生长抑素
奥曲肽
辛伐他汀其他药物/联合 血管升压素+硝酸甘油 血管升压素+硝酸甘油 血管升压素+硝酸甘油 无 NSBB +单硝酸异山梨醇酯 无 无 单硝酸异山梨醇酯
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