概述

What is cirrhosis? A Mayo Clinic expert explains

Learn more about cirrhosis from transplant hepatologist Sumera Ilyas, M.B.B.S.

I'm Dr. Sumera Ilyas, a transplant hepatologist at Mayo Clinic. In this video, we'll cover the basics of cirrhosis. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Put simply, cirrhosis is scarring of the liver. Any time an organ is injured, it tries to repair itself. And when this happens, scar tissue forms. As more scar tissue forms in the liver, it becomes harder for it to function. Cirrhosis is usually a result of liver damage from conditions such as hepatitis B or C, or chronic alcohol use. The damage done by cirrhosis typically cannot be undone. But if caught early enough and depending on the cause, there is a chance of slowing it with treatment. And even in the most severe cases, liver transplants and new treatments provide those suffering from cirrhosis with hope.

Any kind of disease or condition that harms the liver can lead to cirrhosis over time. About 2% of American adults have liver disease, and therefore are at risk of developing cirrhosis. However, those who drink too much alcohol, those who are overweight and those with viral hepatitis are at a greater risk. Not everyone with these risk factors develops cirrhosis. These are the leading causes of liver disease. A wide range of other conditions and diseases can cause cirrhosis as well. Some include inflammation and scarring of the bile ducts, known as primary sclerosing cholangitis; iron buildup in the body - what we call hemochromatosis; Copper accumulation in the liver, which is a rare condition called Wilson's disease; and inflammation from the body's own immune system harming liver cells, known as autoimmune hepatitis.

Often, cirrhosis shows no signs or symptoms until liver damage is extensive. When symptoms do occur, they may first include fatigue, weakness and weight loss, nausea, bruising or bleeding easily, swelling in your legs, feet or ankles, itchy skin, redness on the palms of your hands, and spider-like blood vessels on your skin. During later stages, you might develop jaundice, which is yellowing of the eyes or skin; gastrointestinal bleeding; abdominal swelling from fluid building up in the belly; and confusion or drowsiness. If you notice any of these symptoms, you should speak to your doctor.

Since you may not have any symptoms in the early stages of the disease, cirrhosis is often detected through routine blood tests or checkups. If your doctor find something suspicious, further blood tests may be necessary. These can help identify how extensive your cirrhosis is by checking for liver malfunction, liver damage, or screening for causes of cirrhosis such as hepatitis viruses. Based on the results, your doctor maybe able to diagnose the underlying cause of cirrhosis. They may also recommend imaging tests like an MR elastogram that checks for scarring in the liver, or an MRI of the abdomen, CT scan or an ultrasound. A biopsy may also be required to identify the severity, extent and cause of liver damage.

Although the damage caused by cirrhosis is not reversible, treatment can slow the progression of the disease, alleviate symptoms, and prevent complications. In cases of early cirrhosis, it is possible to minimize damage to the liver by tackling the underlying causes. For instance, treating alcohol addiction, losing weight, and using medications to treat viral hepatitis and other conditions can limit damage to the liver. Once the liver stops functioning, an organ transplant may be an option. During a transplant, surgeons remove the damaged liver and replace it with a healthy working liver. In fact, cirrhosis is one of the most common reasons for a liver transplant. You and your medical team will need to assess if you are an appropriate candidate through a transplant evaluation. Surgery is a big undertaking, one that brings its own risks and complications. And it should always be a decision between you, your family, and your doctors.

If you're concerned about your risk of cirrhosis, talk to your doctor. Life with cirrhosis can be challenging, but with the right information, the right medical team and the right treatment, there's reason to be encouraged. Health professionals learn more and more every day about the conditions and diseases that damage our livers. Studies investigating new treatments that can slow and even reverse the scarring that leads to cirrhosis are currently underway. For those with cirrhosis, the future is brighter than ever before. If you'd like to learn even more about cirrhosis, watch our other related videos or visit mayoclinic.org. We wish you well.

肝硬化是由多种形式的肝病和肝脏病症(例如肝炎和慢性酗酒)引起的肝脏瘢痕(纤维化)的晚期阶段。

每当您的肝脏受到伤害时,无论是疾病、过度饮酒还是其他原因,它都会试图进行自我修复。在这个过程中,会形成瘢痕组织。随着肝硬化的发展,越来越多的瘢痕组织形成,使肝脏难以发挥作用(失代偿性肝硬化)。晚期肝硬化会危及生命。

肝硬化造成的肝损害通常无法挽回。但如果肝硬化得到早期诊断,并针对病因进行治疗,就可以预防进一步的损害,而且极少数情况下会逆转。

症状

在肝脏遭到严重损害之前,肝硬化通常没有相关体征或症状。如果出现体征和症状,可能包括:

  • 疲劳
  • 容易出血或淤血
  • 食欲不振
  • 恶心
  • 腿部、足部或脚踝肿胀(水肿)
  • 体重减轻
  • 皮肤瘙痒
  • 皮肤和眼睛发黄(黄疸)
  • 腹腔积液(腹水)
  • 皮肤上出现蜘蛛状血管
  • 手掌发红
  • 女性会出现与更年期无关的少经或绝经
  • 男性会出现性欲丧失、乳房增大(男性乳腺发育症)或睾丸萎缩
  • 神志不清、嗜睡、言语不清(肝性脑病)

何时就诊

如果您有上述任何体征或症状,请与医生约诊。

病因

有很多疾病和病症可损害肝脏,引起肝硬化。

一些病因包括:

  • 长期酗酒
  • 慢性病毒性肝炎(乙肝、丙肝和丁肝)
  • 肝脏内累积过多的脂肪(非酒精性脂肪性肝病)
  • 体内累积过多的铁(血色素沉着症)
  • 囊性纤维化
  • 肝脏内累积过多的铜(威尔逊氏症)
  • 胆管畸形(胆管闭锁)
  • α1 抗胰蛋白酶缺乏症
  • 遗传性糖代谢疾病(半乳糖血症或糖原储积病)
  • 遗传性消化障碍(Alagille 综合征)
  • 因身体免疫系统引起的肝病(自身免疫性肝炎)
  • 胆管损坏(原发性胆汁性肝硬化)
  • 胆管硬化和瘢痕形成(原发性硬化性胆管炎)
  • 感染,如梅毒或布鲁氏菌病
  • 用药,包括甲氨蝶呤或异烟肼

风险因素

  • 过度饮酒。过度饮酒是导致肝硬化的风险因素。
  • 超重。肥胖会增加您罹患可能导致肝硬化的疾病的风险,比如非酒精性脂肪性肝病和非酒精性脂肪性肝炎。
  • 罹患病毒性肝炎。不是每例慢性肝炎都会发展成肝硬化,但慢性肝炎是世界上导致肝病的主要原因之一。

并发症

肝硬化的并发症可包括:

  • 肝脏供血静脉出现高血压(门静脉高压症)。肝硬化会导致肝脏的正常血流减慢,从而使将血液从肠道和脾脏输送至肝脏的静脉中的压力增加。
  • 腿部和腹部肿胀。门静脉压力增加会导致液体积聚在腿部(水肿)和腹部(腹水)。当肝脏无法产生足够的某些血液蛋白(如白蛋白)时,也可能会引起水肿和腹水。
  • 脾肿大(脾肿大)。门静脉高压症还可引起脾变化和脾肿胀,并捕获白细胞和血小板。血液中白细胞和血小板减少可能是肝硬化的初始体征。
  • 出血。门静脉高压症可导致血液重新导流至较小的静脉。这些额外产生的压力会导致这些较小的静脉破裂,进而引发严重的出血。门静脉高压症可能会导致食管(食管静脉曲张)或胃(胃底静脉曲张)的静脉扩张(静脉曲张),并引发危及生命的出血。如果肝脏不能生产足够的凝血因子,也会导致发生持续出血。
  • 感染。如果患有肝硬化,身体可能会难以抵抗感染。腹水可引发细菌性腹膜炎(严重感染)。
  • 营养不良。肝硬化可能会使身体更难消化吸收营养,进而引起身体虚弱和体重减轻。
  • 脑毒素堆积(肝性脑病)。肝硬化导致肝脏损害后就无法像健康肝脏一样清除血液中的毒素。这些毒素随后会在脑堆积,导致精神错乱和难以集中注意力。随时间推移,肝性脑病可能进展为无反应性或昏迷状态。
  • 黄疸。当患病肝脏无法清除足够的胆红素时,就会发生黄疸,胆红素是一种来自血液的代谢废物。黄疸会引起皮肤和眼白发黄以及尿液变黑。
  • 骨骼疾病。一些肝硬化患者的骨强度损失,骨折风险更大。
  • 患肝癌的风险增加。很大一部分肝癌患者既往都患有肝硬化。
  • 慢加急性肝硬化。一些患者最终会进展为多器官衰竭。当前研究人员认为,在一些肝硬化患者中,这是一种独特的并发症,但他们尚未完全了解其病因。

预防

通过采取以下步骤来护理肝脏,降低肝硬化的风险:

  • 如果您有肝硬化,不要喝酒。如果您有肝病,应该避免饮酒。
  • 健康饮食。选择富含水果和蔬菜的植物性饮食。选择全谷类和瘦肉型蛋白质来源。减少脂肪和油炸食物的摄入量。
  • 保持健康的体重。身体脂肪过多会损害您的肝脏。如果您肥胖或超重,与医生咨询减重。
  • 降低患肝炎的风险。共用针头和无保护措施的性行为会增加您患乙肝和丙肝的风险。向您的医生咨询肝炎疫苗接种。

如果您担心自己有患肝硬化的风险,和您的医生谈谈降低风险的方法。

在 Mayo Clinic 治疗

Feb. 06, 2021
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