Acute variceal bleeding (AVB), which accounts for 70% of all upper gastrointestinal bleeding episodes in cirrhosis,[1] has been identified as a common cause of death in patients with cirrhosis, with a 6-week mortality around 20%.
急性静脉曲张出血(AVB)占肝硬化所有上消化道出血发作的70%，【1】也是AVB肝硬化患者的常见死亡原因，6周内死亡率约为20%【2】。
[At present, progress has been made in the treatment of AVB, including endoscopic treatment, drug therapy, and transjugular intrahepatic portosystemic shunt (TIPS).
目前，AVB的治疗已经取得了进展，包括内镜治疗、药物治疗和经颈静脉肝内门腔分流术(TIPS)。
However, 10–20% of patients with AVB experience treatment failure after initial endoscopic and medical treatment, which is associated with a high short-term risk of further liver decompensation and death.
然而，10-20%的AVB患者在最初的内镜和药物治疗后经历治疗失败，这与进一步的肝脏失代偿和死亡的高短期风险相关。
Several factors have been proposed to identify patients with AVB who are at high risk of poor outcomes and treatment failure, such as the model for end-stage liver disease (MELD) score, renal failure, bacterial infection and active bleeding at endoscopy.
已经提出了一些因素来识别有预后不良和治疗失败高风险的AVB患者，如终末期肝病(MELD)评分模型、肾功能衰竭、细菌感染和内镜下活动性出血。
The Baveno VI Consensus recommends the use of pre-emptive TIPS (pTIPS) in cirrhotic patients with Child-Pugh B cirrhosis and active bleeding at endoscopy despite being on vasoactive drugs, and in patients with Child-Pugh C (<14 points).
BavenoVI 共识建议对肝硬化Child-Pugh B患者，尽管应用血管活性药物内镜下仍发现活动性出血和Child-PughC（＜14分）优先TIPS（p-TIPS）
[8] Several studies have shown that pTIPS placed within 24–72 hours after admission, leads to a significant improvement in relevant clinical outcomes.
一些研究表明，在入院后24-72小时内放置pTIPS，可显著改善相关临床结果。
pTIPS prevents rebleeding and ascites without increasing the complication of hepatic encephalopathy (HE),[13] and is thus a milestone in the treatment of cirrhotic patients with AVB.
TIPS可防止再出血和腹水，而不增加肝性脑病(HE)的并发症，因此是肝硬化AVB患者治疗的一个里程碑。
The benefits of pTIPS probably rely on the prevention of further deterioration after failure of initial treatment, avoiding subsequent increase in rebleeding, organ failure and death.
pTIPS的好处可能依赖于预防初始治疗失败后的进一步恶化，避免随后的再出血、器官衰竭和死亡的增加。
This condition frequently meets the criteria of acute-on-chronic liver failure (ACLF), which comprises a rapidly deteriorating syndrome with extremely high short-term mortality.
这种情况通常符合慢性肝功能衰竭急性进展(acute-on-chronic liver failure ，ACLF)的标准，这包括一种快速恶化的综合征，具有极高的短期死亡率。
With a prevalence of over 22%, ACLF is common in cirrhotic patients with acute decompensation.
患病率超过22%，在肝硬化急性失代偿患者中很常见。
AVB is a well-known trigger for the development of ACLF.
活动性静脉曲张出血（AVB）]是ACLF发展的一个众所周知的触发器。
However, the role of ACLF in the outcome of patients with AVB has not yet been investigated.
]然而，ACLF在AVB患者预后中的作用尚未被研究。
This multicenter, international, observational study addresses 3 clinically relevant issues: i) the prevalence of ACLF at admission in patients with AVB; ii) the influence of ACLF at admission on AVB outcomes (rebleeding and mortality); iii) the impact of pTIPS on mortality of patients with ACLF and AVB.
本多中心、国际、观察性研究解决了3个临床相关问题：
i)AVB患者入院时ACLF的患病率； ii)入院时ACLF对AVB结局（再出血和死亡率）的影响； iii)pTIPS对ACLF和AVB患者死亡率的影响。 |