男性每周喝不少于15杯酒,女性每周喝不少于8杯,即被视为“饮酒过度”。[5]X
可靠来源
Centers for Disease Control and Prevention
前往来源
即使你戒酒了,仍有可能患上肝硬化。但是,还是建议所有肝硬化患者戒酒。不管肝硬化发展到了哪一个阶段,戒酒对治疗和康复有利。[6]X
可靠来源
Johns Hopkins Medicine
前往来源
虽然肝硬化更常见于男性,但女性的肝硬化更有可能是酗酒所致。[7]X研究来源Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.)
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2
检查你是否患有乙(B)型和丙(C)型肝炎。[8]X研究来源Agabegi, S. (2013). Step-up to medicine (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.这两种病毒引发的慢性肝炎和损伤,会在几十年的时间里演变成肝硬化。
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3
留意肝硬化和糖尿病之间的关系。糖尿病是15到30%肝硬化患者患上“非酒精性脂肪性肝炎”的原因。[9]X研究来源Petrides AS, Vogt C, Schulze-Berge D, et al. Prognostic significance of diabetes in patients with cirrhosis. Hepatology 1994; 20:119.慢性丙型肝炎(肝硬化的常见原因)患者因为胰脏功能减弱,也很容易患上糖尿病。
另一个与糖尿病相关,而且会造成肝硬化的情况是血色沉着病。
血色沉着病的特征是过多的铁沉积在皮肤、心脏、关节和胰脏。胰脏沉积了过多铁会引发糖尿病。
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4
留意你目前的体重。肥胖会造成各种健康问题,像是2型糖尿病、心脏病、关节炎和中风。[10]X研究来源肝脏里的多余脂肪引起发炎和损伤,并演变成非酒精性脂肪性肝炎。[11]X研究来源Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.)
利用网上的身高体重指数(BMI)计算器,确认自己的体重是否处于健康范围。[12]X
可靠来源
Mayo Clinic
前往来源
BMI计算方式将你的年龄、身高、性别和体重纳入考量。
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5
了解自体免疫病和心脏病引发肝硬化的风险。如果你患有炎性肠病、类风湿关节炎、甲状腺疾病病等自体免疫病,要多加小心。它们虽然不会直接引起肝硬化,但会增加其它疾病出现并发症的风险,进而引发肝硬化。[13]X研究来源 Agabegi, S. (2013). Step-up to medicine (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.心脏病是非酒精性脂肪性肝炎患者患上肝硬化的原因之一。而且,引起右心衰竭的心脏病会造成肝淤血(豆蔻肝)和心源性肝硬化。[14]X研究来源[15]X研究来源
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6
了解家族病史。某些会引起肝硬化的肝病有遗传性。查看你的家族病史,是否有以下会增加肝硬化风险的遗传病:[16]X研究来源Agabegi, S. (2013). Step-up to medicine (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
遗传性含铁血黄素沉着症[17]X研究来源
威尔森氏病(肝豆状核变性)[18]X
可靠来源
Mayo Clinic
前往来源
α-1抗胰蛋白酶缺乏性肝病[19]X
可靠来源
National Heart, Lung, and Blood Institute
前往来源
方法 2 的 4:
识别症状和迹象
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1
了解肝硬化的症状。一旦出现下面的症状,一定要尽快去看医生。医生可以做出专业诊断,并立刻展开治疗。如果你想知道某个人是否患有肝硬化,一定要带他看医生,因为有的症状可能无法从身体表面观察到。肝硬化的症状包括:[20]X
可靠来源
Mayo Clinic
前往来源
感觉疲惫或很累
容易受瘀伤或流血
下肢水肿
皮肤和眼睛发黄(黄疸)
发烧
食欲不振或体重下降
恶心
腹泻
严重发痒(瘙痒症)
腹围增大
神志不清
睡眠障碍
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2
观察是否出现蜘蛛状血管丝。[21]X研究来源更专业的术语是蜘蛛状血管瘤、蜘蛛痣或蜘蛛状毛细血管扩张症。特征是中心血管有损伤,周围异常的细微静脉丛向四周扩散,形似蜘蛛,通常出现在躯干、脸和上肢。[22]X研究来源Pirovino M, Linder R, Boss C, et al. Cutaneous spider nevi in liver cirrhosis: Capillary microscopic and hormonal investigations. Klin Wochenschr 1988; 66:298.
想要确认是否为蜘蛛状血管瘤,可以用玻璃片压迫可疑的静脉丛。
中心的红点看起来像在搏动,血液流进来时呈红色,血液流到比较小的静脉时则变得苍白。
身上出现多个大面积的蜘蛛状血管瘤是严重肝硬化的迹象。[23]X研究来源Zaman, A, Hapke, R, Flora, K, et al. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol 1999; 94:3292.[24]X研究来源Foutch, PG, Sullivan, JA, Gaines, JA, Sanowski, RA. Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices. Am J Gastroenterol 1988; 83:723.
怀孕和严重营养不良也会引起蜘蛛状血管瘤。有的人虽然很健康,但也会有蜘蛛状血管瘤。
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3
观察手掌是否发红(也就是所谓的“肝掌”)。性激素代谢活动出现变化,导致手掌散布着许多红色斑点。[25]X研究来源Erlinger, S, Benhamou, J. Cirrhosis: Clinical aspects. In: Oxford Textbook of Clinical Hepatology, Mcintyre, N, Benhamou, J, Rizzetto, M, Rodes, J (Eds), University Press, Oxford 1991. p.380.主要影响拇指和小指外侧掌面,中间部分不受影响。
手掌发红的其它原因包括怀孕、类风湿关节炎、甲状腺机能亢进和血液问题。[26]X研究来源Agabegi, S. (2013). Step-up to medicine (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
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4
留意指甲是否有任何变化。肝病经常会影响皮肤,但指甲也能提供有用的信息。米瑞克指甲(Muehrcke’s nails)指的是甲床出现白色横纹(通常成对出现)。这是肝脏没有产生足够的白蛋白所致。[27]X研究来源Fitzpatrick, T, Johnson, R, Polano, M, et al. Color Atlas and Synopsis of Clinical Dermatology: Common and Serious Diseases, Second edition, McGraw Hill, Inc. New York 1994.按压这些指甲会使横纹褪色,然后消失,但很快会再次出现。
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5
检查长骨关节是否肿胀。比如说,膝盖或脚踝关节反复肿胀,可能是“肥大性骨关节病”的迹象。患者也会感到手指和肩膀关节在发炎。这是骨骼周围结缔组织慢性发炎造成的,会非常痛。[28]X研究来源Epstein, O, Dick, R, Sherlock, S. Prospective study of periostitis (inflammation of the dense fibrous membrane covering the surface of bones) and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease. Gut 1981; 22:203.
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7
男性需要检查乳房是否有硬块。男性女乳症指的是男性乳房腺体组织增生,使乳头特别突出。[30]X研究来源Agabegi, S. (2013). Step-up to medicine (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.这是雌二醇激素增加造成的,高达3分之2肝硬化患者有这个症状。男性女乳症可能会看起来像假性男性女乳症。后者不是乳腺增生,而是脂肪堆积,导致胸部变大。
要如何分辨这两种状况呢?首先仰卧,将拇指和食指放在乳房两侧。
手指慢慢合拢。摸摸乳头底下中心位置是否有似橡胶或坚硬的组织。
摸到硬块就是男性女乳症。没有摸到硬块,则是假性男性女乳症。
其它疾病(比如癌症)的硬块一般不在中心(不围绕着乳头)。[31]X研究来源Bickley, L., & Szilagyi, P. (2007). Bates' guide to physical examination and history taking (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
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8
男性需要留意是否出现性腺机能减退的症状。[32]X研究来源Van Thiel, DH, Gavaler, JS, Spero, JA, et al. Patterns of hypothalamic-pituitary-gonadal dysfunction in men with liver disease due to differing etiologies. Hepatology 1981; 1:39.患有肝硬化等慢性肝病的男性会减少分泌睾酮。[33]X
可靠来源
PubMed Central
前往来源
性腺机能减退的症状包括阳痿、不育、没有性欲和睾丸萎缩。原因可能是睾丸受伤,下丘脑或脑下垂体出问题。
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11
留意口腔是否发出霉味。[35]X研究来源 Tangerman, A, Meuwese-Arends, MT, Jansen, JB. Cause and composition of foetor hepaticus. Lancet 1994; 343:483.这是"肝病性口臭"的迹象,是严重高血压所致。海蛇头状脐周静脉曲张和克包二氏杂音也是高血压引起的。高血压造成二甲基硫醚增加,进而引发口臭。
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2
让医生检查克包二氏杂音。[36]X研究来源Groszmann, R, Franchis, R. Portal Hypertension. In: Schiff's Diseases of the Liver, Eighth Edition, Schiff, E, Sorrell, M, Maddrey, W (Eds), Lippincott Williams & Wilkens, Philadelphia 1999. p.415.大部分初级护理医生都不会帮你做这项检查。这是可以透过听诊器在上腹部听到的静脉杂音。它和海蛇头状脐周静脉曲张一样,是静脉血压升高,体内不同静脉系统的连接出了问题造成的。
检测血清转氨酶水平是否升高。这可能是酒精性肝硬化的迹象。酒精性肝硬化患者的天冬氨酸氨基转移酶(AST)和丙氨酸转氨酶(ALT)比例通常大于2。[37]X研究来源 Sheth, SG, Flamm, SL, Gordon, FD, Chopra, S. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 1998; 93:44.[38]X研究来源 Williams, AL, Hoofnagle, JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology 1988; 95:734.
测量总胆红素,然后和基准值做比较。早期肝硬化患者的测试结果可能正常,但总胆红素会随着病情恶化而升高。注意,在原发性胆汁性肝硬化案例中,胆红素升高意味着预后很差。[39]X研究来源 Krzeski, P, Zych, W, Kraszewska, E, et al. Is serum bilirubin concentration the only valid prognostic marker in primary biliary cirrhosis?. Hepatology 1999; 30:865.
其它试验包括碱性磷酸酶、γ-谷酰胺转酞酶[40]X研究来源 Pratt, D, Kaplan, M. Evaluation of the Liver A: Laboratory Tests. In: Schiff's Diseases of the Liver, Eighth Edition, Schiff, E, Sorrell, M, Maddrey, W (Eds), Lippincott Williams & Wilkens, Philadelphia 1999. p.205.[41]X研究来源 Goldberg, DM. Structural, functional, and clinical aspects of gamma-glutamyltransferase. CRC Crit Rev Clin Lab Sci 1980; 12:1.[42]X研究来源 Barouki, R, Chobert, MN, Finidori, J, et al. Ethanol effects in a rat hepatoma cell line: Induction of gamma-glutamyltransferase. Hepatology 1983; 3:323.、前凝血酶时间、球蛋白[43]X研究来源 Triger, DR, Wright, R. Hyperglobulinaemia in liver disease. Lancet 1973; 1:1494.、血清钠[44]X研究来源 Asbert, M, Gines, A, Gines, P, et al. Circulating levels of endothelin in cirrhosis. Gastroenterology 1993; 104:1485.和血钠过低。
核磁共振成像则因为成本高和容易引起患者不适,而很少使用。整个过程十分耗时,而且令人不舒服。T1加权像的信号强度低,表明了遗传性血色沉着病造成体内的铁过多。[46]X研究来源 Ernst, O, Sergeant, G, Bonvarlet, P, et al. Hepatic iron overload: Diagnosis and quantification with MR imaging. AJR Am J Roentgenol 1997; 168:1205.
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1
让医生指导你进行治疗。大部分轻度至中度肝硬化会被安排接受门诊治疗,但也有一些例外情况。消化道严重出血、严重感染或败血症、肾脏功能衰竭或精神状况改变的患者需要接受住院治疗。[47]X研究来源Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.).
爆发性肝功能衰竭,指的是肝性脑病突然发作(大脑结构或功能在诊断出肝硬化的8周内出现变化)。这种情况需要进行肝脏移植。[50]X研究来源 Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.).
肝细胞癌指的是肝脏长恶性肿瘤。治疗方法包括射频消融术、切除术(做手术切除肿瘤)和肝脏移植。[51]X研究来源 Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.).
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4
了解你的预后。诊断出肝硬化后,如果只有很少症状或没有症状,患者一般还能活5到20年。[52]X研究来源 Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.).一旦出现严重症状和并发症,如果没有进行肝脏移植,通常会在5年内死亡。[53]X研究来源 Domino, F. (n.d.). The 5-minute clinical consult standard 2015 (23rd ed.).