肝硬化自发性门静脉分流：目前的认识和未来的展望

Spontaneous Portal Shunt in Liver Cirrhosis: Current Understanding and Future Perspectives

摘要: 由各种原因引起肝硬化后，肝脏内假小叶生成，肝脏实质纤维化，肝内血管阻力增加，从而引起门静脉压力升高；机体可通过2种方式代偿门静脉高压：一种为内脏血管扩张，另一种为自发性门体分流(SPSS)；长期以来，自发性门体分流被认为是一种门静脉系统减压的代偿机制，现在看来，自发性门体分流不仅在降低门静脉高压方面效率十分低下，而且还会导致肝细胞灌注减少、内脏血流量和阻力增加，从而进一步导致门静脉高压及肝功能恶化。目前，在多项研究中均发现肝硬化患者SPSS的高患病率，并观察到SPSS的存在与较差的临床结果之间有关联。SPSS可单独增加肝性脑病、静脉曲张出血和腹水的风险，并可降低患者的生存率；此外，在经颈静脉肝内门体分流术和肝移植患者中SPSS的存在对术后结果均有不同程度的影响。这篇文章概述了自发性门体分流的临床特点和对肝硬化病程的影响，以及未来对其作为治疗靶点的展望。

Abstract: After liver cirrhosis caused by various reasons, pseudolobules in the liver, fibrosis in the liver pa-renchyma, and increased resistance of blood vessels in the liver, resulting in increased portal vein pressure; The body can compensate for portal hypertension in two ways: one is visceral vasodilation, the other is spontaneous portosystemic shunt (SPSS); For a long time, spontaneous portosystemic shunt has been considered as a compensatory mechanism for the decompression of the portal vein system. Now, it seems that spontaneous portosystemic shunt is not only very inefficient in reducing portal hypertension, but also leads to decreased hepatocyte perfusion, increased visceral blood flow and resistance, which further leads to portal hypertension and deterioration of liver function. At present, the high prevalence of SPSS in patients with liver cirrhosis has been found in many studies, and the association between the existence of SPSS and poor clinical results has been observed. SPSS alone can increase the risk of hepatic encephalopathy, variceal bleeding and ascites, and can reduce the survival rate of patients; In addition, the presence of SPSS in patients undergoing transjugular intrahepatic portosystemic shunt and liver transplantation has different effects on the postopera-tive results. This article summarizes the clinical characteristics of spontaneous portosystemic shunt and its impact on the course of cirrhosis, as well as the prospect of its use as a therapeutic target in the future.