英国2006肝硬化腹水处理指南.docVIP

肝硬化腹水处理指南（2006年英国） K P Moore, G P Aithal 1.0 INTRODUCTION Ascites is a major complication of cirrhosis,1 occurring in 50% of patients over 10 years of follow up.2 The development of ascites is an important landmark in the natural history of cirrhosis as it is associated with a 50% mortality over two years,2–5 and signifies the need to consider liver transplantation as a therapeutic option.3 The majority (75%) of patients who present with ascites have underlying cirrhosis, with the remainder being due to malignancy (10%), heart failure (3%), tuberculosis (2%), pancreatitis (1%), and other rare causes.6 The true prevalence and incidence of cirrhosis of the liver and its complications in the UK are unknown. Mortality from cirrhosis has increased from 6 per 100 000 population in 1993 to 12.7 per 100 000 population in 2000.7 Approximately 4% of the general population have abnormal liver function or liver disease8 and approximately 10–20% of those with one of the three most common chronic liver diseases (non-alcoholic fatty liver disease, alcoholic liver disease, and chronic hepatitis C) develop cirrhosis over a period of 10–20 years. With a rising frequency of alcoholic and non-alcoholic fatty liver disease, a huge increase in the burden of liver disease is expected over the next few years8 with an inevitable increase in the complications of cirrhosis. There have been several changes in the clinical management of cirrhotic ascites over recent years, and the purpose of these guidelines is to promote a consistent clinical practice throughout the UK. 1.0绪论 腹水是肝硬化的一个主要并发症，1随访超过10年的病人中50％发生。2腹水的出现在肝硬化自然史中是一个重要的里程碑，因为其标示着2年间有50％的死亡率，2-5而且意味着需要考虑进行肝移植做为治疗方案。3以腹水为表现的病人大部分（75％）有潜在的肝硬化，其余的可能是恶性肿瘤（10%）、心衰（3%）、结核（2%）、胰腺炎（1％）和其它少见原因。6英国肝硬化真正的流行情况和发生率及其并发症尚不清楚。肝硬化的死亡率已经从1993年的6/10万上升到了2000年的12.7/10万。7普通人群中约4%有肝功能异常或肝病8，患三种最常见的慢性肝病（非酒精性脂肪肝，酒精性脂肪肝和慢性丙型肝炎）之一的病人约10-20％在10-20年间会发展成肝硬化。随着酒精性和非酒精性脂肪肝发生率的上升，在今后的数年间肝病的负担会大幅增加8并且不可避免要伴随着肝硬化并发症增加。在最近的几年间肝硬化腹水的临床处理上已有几个变化，本指南的目的是在全英国倡仪一个一致性的临床实践。