肝硬化再代偿相关研究进展

Research Progress on the Recompensation of Liver Cirrhosis

摘要: 肝硬化失代偿期是慢性肝病自然史中的一个关键分水岭，标志着疾病由相对稳定阶段进入高风险阶段，患者常出现难治性腹水、食管胃静脉曲张破裂出血、肝性脑病及感染等一系列危及生命的并发症，预后显著恶化。长期以来，临床普遍认为肝硬化一旦由代偿期进展至失代偿期，其病理改变和临床结局难以逆转。然而，近年来随着抗病毒治疗、病因控制及综合管理策略的不断进步，研究发现部分失代偿期肝硬化患者在病因得到有效控制后，可在较长时间内不再发生新的失代偿事件，并伴随肝功能指标和门静脉高压状态的改善。基于这一新的认识，Baveno VII共识正式提出并定义了“肝硬化再代偿”这一概念，并明确了相应的诊断标准。本文在此基础上系统总结了肝硬化再代偿的最新研究进展，重点围绕其早期预测因子、可能的病理生理机制以及现有和潜在的治疗策略进行探讨，旨在为再代偿理念在临床实践中的应用和患者长期管理提供参考依据。

Abstract: Decompensated cirrhosis represents a pivotal milestone in the natural history of chronic liver disease, signifying the transition from a relatively stable compensated stage to a high-risk phase. This stage is commonly characterized by the development of life-threatening complications, including refractory ascites, esophagogastric variceal hemorrhage, hepatic encephalopathy, and bacterial infections, and is associated with a substantially worsened prognosis. For decades, the progression from compensated to decompensated cirrhosis has been widely regarded as an irreversible process, with limited potential for regression in hepatic architecture or clinical outcomes. In recent years, however, advances in antiviral therapies, effective etiological control, and optimized comprehensive management have challenged this traditional paradigm. Emerging evidence indicates that a subset of patients with decompensated cirrhosis, following sustained control or removal of the underlying cause, may remain free from further decompensating events over a prolonged period, accompanied by improvements in liver function and a reduction in portal hypertension. In recognition of this evolving concept, the Baveno VII consensus formally introduced the term “recompensated cirrhosis” and established standardized diagnostic criteria. On this basis, the present review summarizes recent advances in the understanding of recompensated cirrhosis, with particular emphasis on early predictive factors, underlying pathophysiological mechanisms, and currently available as well as emerging therapeutic strategies. This overview aims to provide a comprehensive framework to facilitate the integration of the recompensation concept into clinical practice and the long-term management of patients with advanced cirrhosis.