门脉高压

门脉高压
门脉高压
	The portal vein and its tributaries
症状	腹水、黄疸、脾肿大[*]、微血管扩张
类型	hepatic vascular disease[]、高血压[]、疾病
病因	门静脉血栓[]、血吸虫病、肝硬化、限制型心肌病[]、心包炎
分类和外部资源
医学专科	Gastroenterology
ICD-11	DB98.7
ICD-9-CM	572.3
DiseasesDB	10388
eMedicine	182098
	[编辑此条目的维基数据]

门脉高压（英语：Portal hypertension）为描述肝门静脉系统（英语：hepatic portal system）高压的状态。目前的定义为肝门静脉梯度（英语：hepatic venous pressure gradient）高于或等于6mmHg^[1]。门脉高压最常见的原因就是肝硬化，其他较罕见的原因则称为非肝硬化性门脉高压（non-cirrhotic portal hypertension）。当门脉高压已造成问题，则必须适当纾解门脉压力^{[来源请求]}。

症状和征象

门脉高压的症状和征象包含：

腹水^[2]
- 腹痛或腹胀^[3]，如果合并细菌感染则称为自发性细菌性腹膜炎（英语：Spontaneous bacterial peritonitis）
脾肿大（英语：Splenomegaly）^[2]，可能导致血小板数量降低
食道静脉曲张（英语：Oesophageal varices），可能破裂导致呕血^{[来源请求]}。
前腹壁静脉曲张（有时又称Caput medusae（英语：Caput medusae））^[2]
痔疮^[4]

病因

门脉高压可借由病灶发生的位置分为肝前性、肝内性、肝后性等。最常见的因素为肝硬化，其他原因则包含^[2]^[5]^[6]：

	非肝硬化性门脉高压的相关因子
肝前性	门静脉（英语：Portal vein thrombosis）或脾静脉（英语：splenic vein）血栓
	动静脉瘘管
	脾肿大（增加门脉血流）
肝内性	所有造成肝硬化的原因，包含酗酒、慢性病毒性肝炎、胆道闭锁（英语：biliary atresia）等等
	Primary biliary cirrhosis
	Primary sclerosing cholangitis
	Chronic pancreatitis
	Hereditary haemorrhagic telangiectasia
	血吸虫症
	Congenital hepatic fibrosis
	Nodular regenerative hyperplasia
	Fibrosis of space of Disse
	Granulomatous or infiltrative liver diseases (Gaucher, mucopolysaccharidosis, sarcoidosis, lymphoproliferative malignancies, amyloid deposition, …)
	毒素（如砷、铜、氯乙烯、矿物油、维生素A、azathioprine、dacarbazine、methotrexate、amiodarone...）
	病毒性肝炎
	脂肪肝
	Veno-occlusive disease
肝后性	下腔静脉阻塞
	(Right-sided) heart failure, e.g. from constrictive pericarditis（英语：constrictive pericarditis）
	布加综合征
	Budd-Chiari syndrome

病生理

Stellate cell

门脉高压的直接原因主要是血管的阻力增加，但造成血管阻力增加的原因则相当多样。一般来说还会合并星状细胞及肌成纤维细胞（英语：myofibroblasts）活化。内源性血管扩张剂也可能导致静脉血流增加^[2]^[7]。

参考文献

^ Portal hypertension | Disease | Overview | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. [2016-01-08]. （原始内容存档于2016-01-27）.
^ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 Portal Hypertension. Learn about Portal Hypertension | Patient. Patient. [2016-01-08]. （原始内容存档于2021-01-19）（英国英语）.
^ Spontaneous Bacterial Peritonitis. www.karger.com. [2016-01-08]. （原始内容存档于2020-05-10）.
^ Sun, Z; Migaly, J. Review of Hemorrhoid Disease: Presentation and Management.. Clinics in colon and rectal surgery. March 2016, 29 (1): 22–9. PMID 26929748. doi:10.1055/s-0035-1568144.
^ Bloom, S.; Kemp, W.; Lubel, J. Portal hypertension: pathophysiology, diagnosis and management. Internal Medicine Journal. 2015-01-01, 45 (1): 16–26 [2017-01-03]. ISSN 1445-5994. doi:10.1111/imj.12590. （原始内容存档于2017-09-14）.
^ Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. Robbins basic pathology 9th. Philadelphia, PA: Elsevier/Saunders. : 608. ISBN 978-1-4377-1781-5. 2013
^ Portal Hypertension: Practice Essentials, Background, Anatomy. [2017-01-03]. （原始内容存档于2021-05-06）.

延伸阅读

Garbuzenko D.V., Arefyev N.O., Belov D.V. Mechanisms of adaptation of the hepatic vasculature to the deteriorating conditions of blood circulation in liver cirrhosis. World J. Hepatol. 2016; 8 (16): 665-672.
Garbuzenko D.V. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr. Med. Res. Opin. 2016; 32 (3): 467-475.
Garbuzenko D.V. Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis. World J. Gastroenterol. 2015; 21 (20): 6117-6126.
Functional aspects on the pathophysiology of portal hypertension in cirrhosis – Journal of Hepatology. www.journal-of-hepatology.eu. [2016-01-08]. （原始内容存档于2019-07-10）.
Rossi, Plinio. Portal Hypertension: Diagnostic Imaging and Imaging-Guided Therapy. Springer Science & Business Media. 2012-12-06 [2017-01-03]. ISBN 9783642571169. （原始内容存档于2020-08-31）.
Imanieh, Mohammad Hadi; Dehghani, Seyed Mohsen; Khoshkhui, Maryam; Malekpour, Abdorrasoul. Etiology of Portal Hypertension in Children:A Single Center’s Experiences. Middle East Journal of Digestive Diseases. 2012-10-01, 4 (4): 206–210. ISSN 2008-5230. PMC 3990125  . PMID 24829658.

外部链接

Ascites at Merck Manual of Diagnosis and Therapy（英语：Merck Manual of Diagnosis and Therapy） Home Edition
Children's Liver Disease Foundation （页面存档备份，存于互联网档案馆）

[1] Portal hypertension | Disease | Overview | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. [2016-01-08]. （原始内容存档于2016-01-27）.

[patient-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 Portal Hypertension. Learn about Portal Hypertension | Patient. Patient. [2016-01-08]. （原始内容存档于2021-01-19）（英国英语）.

[3] Spontaneous Bacterial Peritonitis. www.karger.com. [2016-01-08]. （原始内容存档于2020-05-10）.

[4] Sun, Z; Migaly, J. Review of Hemorrhoid Disease: Presentation and Management.. Clinics in colon and rectal surgery. March 2016, 29 (1): 22–9. PMID 26929748. doi:10.1055/s-0035-1568144.

[5] Bloom, S.; Kemp, W.; Lubel, J. Portal hypertension: pathophysiology, diagnosis and management. Internal Medicine Journal. 2015-01-01, 45 (1): 16–26 [2017-01-03]. ISSN 1445-5994. doi:10.1111/imj.12590. （原始内容存档于2017-09-14）.

[Robbins_9th_Edition-6] Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. Robbins basic pathology 9th. Philadelphia, PA: Elsevier/Saunders. : 608. ISBN 978-1-4377-1781-5. 2013

[7] Portal Hypertension: Practice Essentials, Background, Anatomy. [2017-01-03]. （原始内容存档于2021-05-06）.

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