The aim of review

gastro-j

Российский журнал гастроэнтерологии, гепатологии, колопроктологии

Russian Journal of Gastroenterology, Hepatology, Coloproctology

1382-43762658-6673

«Gastro» LLC

gastro-j-1331

Research Article

ГЕПАТОЛОГИЯ

HEPATOLOGY

Геморрагический синдром при циррозе печени

Hemorrhagic syndrome at liver cirrhosis

Куркина

И. А.

Kurkina

I. A.

Волкова

О. С.

Volkova

O. S.

Маевская

М. В.

Mayevskaya

M. V.

Ивашкин

В. Т.

Ivashkin

V. T.

ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФРоссияState educational government-financed institution of higher professional education Sechenov First Moscow state medical university of the Russian federation Ministry of health and social developmentRussian Federation

2012

01112012

2261421

2012

Куркина И.А., Волкова О.С., Маевская М.В., Ивашкин В.Т.

Kurkina I.A., Volkova O.S., Mayevskaya M.V., Ivashkin V.T.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.gastro-j.ru/jour/article/view/1331

Цель обзора. Осветить различные взгляды на геморрагические осложнения у пациентов с циррозом печени (ЦП), связь подобных осложнений с нарушениями системы гемостаза.Основные положения. Физиология системы гемостаза тесно связана с функцией печени, потому что паренхиматозные клетки вырабатывают большинство факторов свертывающей и фибринолитической систем. Следовательно, хронические или острые заболевания указанного органа часто имеют глубокое воздействие на систему гемостаза. Кровотечения, возникающие при проведении инвазивных процедур у больных ЦП, кровотечения из варикозных вен пищевода, гематомы, геморрагическая пурпура, носовое кровотечение, кровотечение из десен, меноррагии являются актуальной клинической проблемой.Лабораторная диагностика нарушений в системе гемостаза-фибринолиза у пациентов с ЦП претерпела за последнее десятилетие существенные изменения. Стандартные комплексные тесты гемостаза теряют свою диагностическую ценность у данной категории больных. Ведется активный поиск лабораторных методов, позволяющих оценить риск развития кровотечения у лиц, страдающих циррозом печени.Стратегия в лечении геморрагических осложнений при ЦП направлена на проведение профилактических мероприятий в ожидании кровотечения и своевременное начало лечебных мероприятий в случае его возникновения. Основными принципами терапии являются: применение эритроцитов, плазмы, концентрата тромбоцитов, рекомбинантного фактора VIIa, концентратов протромбинового комплекса, десмопрессина, антифибринолитиков, тромбои эритропоэтина, антибиотиков. Отношение к назначению компонентов крови в настоящее время очень осторожное, отсутствуют четкие показания к их использованию и критерии эффективности.Заключение. Проблема прогнозирования геморрагических осложнений у больных ЦП с помощью современных лабораторных тестов остается открытой. Отсутствует общепризнанная стратегия лечения и профилактики кровотечений у данной категории больных. Необходимо проведение рандомизированных контролируемых исследований для оценки значимости лабораторных тестов в прогнозировании кровотечений или тромбозов у больных с циррозами, для изучения эффективности использования современных концентратов факторов свертывания, для оценки применения ограничительной политики переливания компонентов крови.

The aim of review

The aim of review. To demonstrate different points of view on hemorrhagic complications in patients with liver cirrhosis (LC), relation of these complications to disorders of hemostatic system.

Key points

Key points. Physiology of hemostatic system is intimately related to liver function because parenchymatous cells produce the majority of coagulating and fibrinolytic systems factors. Hence, chronic or acute diseases of this organ frequently have profound effect the system of hemostasis. Bleeding developing at invasive procedures in LC patients, bleeding from varicose esophageal veins, hematomas, hemorrhagic purpura, nasal bleeding, odontorrhagia, menorrhagias are actual clinical problems. Laboratory diagnostics of disorders in «hemostasisfibrinolysis» system in patients with the LC underwent essential changes at the last decade. Standard complex tests for hemostasis lose their diagnostic value in this group of patients. Active search of the laboratory methods is conducted, allowing to estimate the risk of bleeding in liver cirrhosis patients. Strategy in treatment of hemorrhagic complications in LC is directed on prevention of pending bleedings and well-timed onset of medical actions in the case of its development. Basic principles of therapy are: application of erythrocytes, plasma, platelets concentrate, recombinant factor VIIa, concentrates of prothrombin complex, desmopressin, antifibrinolytic drugs, thrombo-and erythropoietin, antibiotics. The relation to prescription of components of blood is cautious now, there are no definite indications to their application and criteria of efficacy.

Conclusion

Conclusion. The problem of prediction of hemorrhagic complications in patients with LC by modern laboratory tests remains open. There is no conventional strategy of treatment and prophylaxis of bleedings for these patients. Carrying out of randomized controlled studies for evaluation of laboratory tests in prediction of bleedings or thromboses at patients with cirrhoses, for studying efficacy of modern concentrates of factors of coagulation, for assessment of restrictive policy of decantation of blood components is necessary.

цирроз печенигеморрагический синдромкровотечениеаномальные коагуляционные тестыинвазивные процедурыкомпоненты кровиконцентраты факторов свертывания

liver cirrhosishemorrhagic syndromebleedingabnormal coagulation testsinvasive procedurescomponents of bloodconcentrates of factors of coagulation

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The authors declare that there are no conflicts of interest present.