Factori de recompensație la pacienții cu ciroză decompensată
Keywords:
liver cirrhosis, decompensation, anti-viral therapy, alcohol abstinenceAbstract
Ciroza decompensată marchează o etapă ireversibilă în boala hepatică cronică. Tratamentul etiologic eficient poate induce recompensarea hepatică. Noi am evaluat factorii care contribuie la îmbunătățirea stării pacienților cu ciroză hepatică decompensată. La baza aceastui riviu o fost evaluarea literaturii din bazele de date PubMed, Clinical Review și Google Scholar, concentrându-se pe articole, meta-analize și referințe din articole și manuale relevante publicate între 2021 și 2024. Analiza literaturii actuale demonstrează că terapia antivirală și renunțarea la consumul de alcool îmbunătățesc semnificativ prognosticul și facilitează recompensarea hepatică la pacienții cu ciroză decompensată. Fiziopatologia recompensării în ciroză implică mai multe mecanisme: reducerea leziunilor hepatice, regenerarea hepatocitelor, rezolvarea fibrozei, reducerea hipertensiunii portale, îmbunătățirea hemodinamicii (scăderea debitului cardiac, vasodilatația splahnică și îmbunătățirea răspunsului vascular). Pacienții care ating nivelurile ADN HBV <20 IU/ml în timpul terapiei antivirale atestă rezolvarea ascitei, encefalopatiei și absența sângerărilor variceale recurente timp de cel puțin 12 luni. Pacienții cu ciroză hepatică decompensată de etiologie virală HCV, în cazul obținerii răspunsului virologic susținut, au o mare șansă de a obține recompensarea post tratament. De asemenea, pacienții cu ciroză decompensată asociată consumului de alcool au atins recompensarea prin abstinență susținută. Recompensarea a devenit un focus semnificativ în studiul cirozei, în special în cazurile de boală hepatică cronică cu cauze cunoscute, cum ar fi hepatita virală și consumul de alcool. Obținerea recompensării la pacienții cu ciroză legată de virus și alcool este promițătoare, dar sunt necesare mai multe studii pentru a înțelege mecanismele sale subiacente și caracteristicile clinice.
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