Community-based Management Recommendations of Patients with Decompensated Liver Cirrhosis

doi:10.12114/j.issn.1007-9572.2020.00.341

Abstract

Abstract: Based on the review of the 2018 EASL Clinical Practice Guidelines for the Management of Patients with Decompensated Cirrhosis，we discussed community-based diagnostic and therapeutic management of decompensated cirrhosis patients，hoping to help general practitioners to make rational management decisions and deliver preventive interventions benefiting the prognosis and quality of life when managing such patients.

Key words: Decompensated cirrhosis, Complications, Management, Practice Guidelines, General Practice

摘要： 本文结合2018年欧洲肝脏研究学会发布的《失代偿期肝硬化患者的管理临床实践指南》中关于失代偿期肝硬化相关并发症的诊疗，引发对失代偿期肝硬化患者诊疗环节中社区管理的讨论，以期全科医生在诊疗和预防工作中做出合理决策，提高该类患者的预后、生活质量等。

关键词: 失代偿期肝硬化, 并发症, 管理, 实践指南, 全科医学

CHEN Juan,YIN Xuehong,MENG Qinghua. Community-based Management Recommendations of Patients with Decompensated Liver Cirrhosis[J]. Chinese General Practice, 2020, 23(23): 2863-2871. DOI: 10.12114/j.issn.1007-9572.2020.00.341.
陈娟,尹学红,孟庆华. 失代偿期肝硬化患者的社区管理建议[J]. 中国全科医学, 2020, 23(23): 2863-2871. DOI: 10.12114/j.issn.1007-9572.2020.00.341.

References

［1］赵静如，韩一平.从全科医学发展看全科医生培养［J］．中国继续医学教育，2016，8（23）：1-3．DOI：10.3969/j.issn.1674-9308.2016.23.001.
ZHAO J R，HAN Y P.General practitioner training from the perspective of general practice development［J］．China Continuing Medical Education，2016，8（23）：1-3．DOI：10.3969/j.issn.1674-9308.2016.23.001.
［2］D'AMICO G，GARCIA-TSAO G，PAGLIARO L.Natural history and prognostic indicators of survival in cirrhosis：a systematic review of 118 studies［J］．J Hepatol，2006，44（1）：217-231．DOI：10.1016/j.jhep.2005.10.013.
［3］BERNARDI M，MOREAU R，ANGELI P，et al．Mechanisms of decompensation and organ failure in cirrhosis：from peripheral arterial vasodilation to systemic inflammation hypothesis［J］．J Hepatol，2015，63（5）：1272-1284．DOI：10.1016/j.jhep.2015.07.004.
［4］PLANAS R，MONTOLIU S，BALLESTE B，et al．Natural history of patients hospitalized for management of cirrhotic ascites［J］．Clin Gastroenterol Hepatol，2006，4（11）：1385-1394.
［5］KRAG A，BENDTSEN F，HENRIKSEN J H，et al．Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites［J］．Gut，2010，59（1）：105-110．DOI：10.1136/gut.2009.180570.
［6］吴浩，吴永浩，屠志涛.全科临床诊疗常规（配增值）［M］．北京：中国医药科技出版社，2018.
［7］王莹.全科医生在社区慢病控制三级预防体系中的作用和优势［J］．中国卫生产业，2019，16（32）：63-65.
［8］SCHRIER R W，ARROYO V，BERNARDI M，et al．Peripheral arterial vasodilation hypothesis：a proposal for the initiation of renal sodium and water retention in cirrhosis［J］．Hepatology，1988，8（5）：1151-1157．DOI：10.1002/hep.1840080532.
［9］SUNG J J，TSOI K K，WONG V W，et al．Meta-analysis：Treatment of hepatitis B infection reduces risk of hepatocellular carcinoma［J］．Aliment Pharmacol Ther，2008，28（9）：1067-1077．DOI：10.1111/j.1365-2036.2008.03816.x.
［10］张平.社区戒酒督导对提高酒精性肝病患者生活质量的影响［J］．肝脏，2014，19（7）：558-559．DOI：10.14000/j.cnki.issn.1008-1704.2014.07.026.http：//www.cnki.com.cn/Article/CJFDTotal-ZUAN201407026.htm.
［11］黎俊，韩涛.酒精性肝病与营养不良［J］．实用肝脏病杂志，2012，15（3）：191-193．DOI：10.3969/j.issn.1672-5069.2012.03.006.http：//www.cnki.com.cn/Article/CJFDTotal-GBSY201203005.htm.
［12］CARVALHO L，PARISE E R.Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis［J］．Arq Gastroenterol，2006，43（4）：269-274．DOI：10.1590/s0004-28032006000400005.
［13］王剑，刘殿武，詹思延.药物性肝病流行病学研究进展［J］．现代预防医学，2010，37（7）：1393-1394，1397.
［14］BIOUR M，JAILLON P.Drug-induced hepatic diseases［J］．Pathol Biol，1999，47（9）：928-937.
［15］KAPLOWITZ N.Drug-induced liver disorders：implications for drug development and regulation［J］．Drug Saf，2001，24（7）：483-490．DOI：10.2165/00002018-200124070-00001.
［16］GINéS P，QUINTERO E，ARROYO V，et al．Compensated cirrhosis：natural history and prognostic factors［J］．Hepatology，1987，7（1）：122-128．DOI：10.1002/hep.1840070124.
［17］MOORE K P，WONG F，GINES P，et al．The management of ascites in cirrhosis：report on the consensus conference of the International Ascites Club［J］．Hepatology，2003，38（1）：258-266．DOI：10.1053/jhep.2003.50315.
［18］ARROYO V，GINèS P，GERBES A L，et al．Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis.International Ascites Club［J］．Hepatology，1996，23（1）：164-176．DOI：10.1002/hep.510230122.
［19］PERICLEOUS M，SARNOWSKI A，MOORE A，et al．The clinical management of abdominal ascites，spontaneous bacterial peritonitis and hepatorenal syndrome：a review of current guidelines and recommendations［J］．Eur J Gastroenterol Hepatol，2016，28（3）：e10-18．DOI：10.1097/MEG.0000000000000548.
［20］European Association for the Study of the Liver.Electronic Address：Easloffice@asloffice.eu，European Association fot the Study of the Liver.EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis［J］．J Hepatol，2018，69（2）：406-460．DOI：10.1016/j.jhep.2018.03.024.
［21］BERNARDI M，LAFFI G，SALVAGNINI M，et al．Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis：a randomized controlled clinical trial comparing two diets with different sodium content［J］．Liver，1993，13（3）：156-162．DOI：10.1111/j.1600-0676.1993.tb00624.x.
［22］GAUTHIER A，LEVY V G，QUINTON A，et al．Salt or no salt in the treatment of cirrhotic ascites：a randomised study［J］．Gut，1986，27（6）：705-709．DOI：10.1136/gut.27.6.705.
［23］SANTOS J，PLANAS R，PARDO A，et al．Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis.A randomized comparative study of efficacy and safety［J］．J Hepatol，2003，39（2）：187-192．DOI：10.1016/s0168-8278（03）00188-0.
［24］ANGELI P，FASOLATO S，MAZZA E，et al．Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis：results of an open randomised clinical trial［J］．Gut，2010，59（1）：98-104．DOI：10.1136/gut.2008.176495.
［25］GERBES A L，BERTHEAU-REITHA U，FALKNER C，et al．Advantages of the new loop diuretic torasemide over furosemide in patients with cirrhosis and ascites.A randomized，double blind cross-over trial［J］．J Hepatol，1993，17（3）：353-358．DOI：10.1016/s0168-8278（05）80217-x.
［26］LIN C H，SHIH F Y，MA M H，et al．Should bleeding tendency deter abdominal paracentesis?［J］．Dig Liver Dis，2005，37（12）：946-951．DOI：10.1016/j.dld.2005.07.009.
［27］GINèS P，TITó L，ARROYO V，et al．Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis［J］．Gastroenterology，1988，94（6）：1493-1502．DOI：10.1016/0016-5085（88）90691-9.
［28］BERNARDI M，CARACENI P，NAVICKIS R J，et al．Albumin infusion in patients undergoing large-volume paracentesis：a meta-analysis of randomized trials［J］．Hepatology，2012，55（4）：1172-1181．DOI：10.1002/hep.24786.
［29］赵满汉.肝硬化腹水家庭护理经验与交流［J］．中国社区医师：医学专业半月刊，2008，10（20）：174.http：//www.cnki.com.cn/Article/CJFDTotal-ZGSQ200820227.htm.
［30］PIANO S，FASOLATO S，SALINAS F，et al．The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis：Results of a randomized，controlled clinical trial［J］．Hepatology，2016，63（4）：1299-1309．DOI：10.1002/hep.27941.
［31］KIM J J，TSUKAMOTO M M，MATHUR A K，et al．Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis［J］．Am J Gastroenterol，2014，109（9）：1436-1442．DOI：10.1038/ajg.2014.212.
［32］杨蕊旭，范建高.欧洲失代偿期肝硬化并发症管理指南简介［J］．实用肝脏病杂志，2018，21（4）：496-501．DOI：10.3969/j.issn.1672-5069.2018.04.003.
［33］史慧敏，李瑞，陈红，等．《2018年欧洲肝病学会失代偿期肝硬化患者的管理临床实践指南》摘译［J］．临床肝胆病杂志，2018，34（8）：1632-1638.
［34］RIMOLA A，GARCíA-TSAO G，NAVASA M，et al．Diagnosis，treatment and prophylaxis of spontaneous bacterial peritonitis：a consensus document.International Ascites Club［J］．J Hepatol，2000，32（1）：142-153．DOI：10.1016/s0168-8278（00）80201-9.
［35］BIGGINS S W，RODRIGUEZ H J，BACCHETTI P，et al．Serum sodium predicts mortality in patients listed for liver transplantation［J］．Hepatology，2005，41（1）：32-39．DOI：10.1002/hep.20517.
［36］PORCEL A，DíAZ F，RENDóN P，et al．Dilutional hyponatremia in patients with cirrhosis and ascites［J］．Arch Intern Med，2002，162（3）：323-328．DOI：10.1001/archinte.162.3.323.
［37］CóRDOBA J，GARCíA-MARTINEZ R，SIMóN-TALERO M.Hyponatremic and hepatic encephalopathies：similarities，differences and coexistence［J］．Metab Brain Dis，2010，25（1）：73-80．DOI：10.1007/s11011-010-9172-3.
［38］AMODIO P，DEL PICCOLO F，PETTENò E，et al．Prevalence and prognostic value of quantified electroencephalogram （EEG） alterations in cirrhotic patients［J］．J Hepatol，2001，35（1）：37-45．DOI：10.1016/s0168-8278（01）00129-5.
［39］LONDO?O M C，GUEVARA M，RIMOLA A，et al．Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation［J］．Gastroenterology，2006，130（4）：1135-1143．DOI：10.1053/j.gastro.2006.02.017.
［40］SPASOVSKI G，VANHOLDER R，ALLOLIO B，et al．Clinical practice guideline on diagnosis and treatment of hyponatraemia［J］．Intensive Care Med，2014，40（3）：320-331．DOI：10.1007/s00134-014-3210-2.
［41］D'AMICO G，DE FRANCHIS R，COOPERATIVE STUDY GROUP.Upper digestive bleeding in cirrhosis.Post-therapeutic outcome and prognostic indicators［J］．Hepatology，2003，38（3）：599-612．DOI：10.1053/jhep.2003.50385.
［42］JEPSEN P，OTT P，ANDERSEN P K，et al．Clinical course of alcoholic liver cirrhosis：a Danish population-based cohort study［J］．Hepatology，2010，51（5）：1675-1682．DOI：10.1002/hep.23500.
［43］ABRALDES J G，BUREAU C，STEFANESCU H，et al．Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis：the “Anticipate” study［J］．Hepatology，2016，64（6）：2173-2184．DOI：10.1002/hep.28824.
［44］DE FRANCHIS R，BAVENO VI FACULTY.Expanding consensus in portal hypertension：Report of the Baveno VI Consensus Workshop：Stratifying risk and individualizing care for portal hypertension［J］．J Hepatol，2015，63（3）：743-752．DOI：10.1016/j.jhep.2015.05.022.
［45］GARCIA-TSAO G，SANYAL A J，GRACE N D，et al．Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis［J］．Hepatology，2007，46（3）：922-938．DOI：10.1002/hep.21907.
［46］North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices.Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices.A prospective multicenter study［J］．N Engl J Med，1988，319（15）：983-989．DOI：10.1056/NEJM198810133191505.
［47］PUENTE A，HERNáNDEZ-GEA V，GRAUPERA I，et al．Drugs plus ligation to prevent rebleeding in cirrhosis：an updated systematic review［J］．Liver Int，2014，34（6）：823-833．DOI：10.1111/liv.12452.
［48］MERLI M，NICOLINI G，ANGELONI S，et al．Incidence and natural history of small esophageal varices in cirrhotic patients［J］．J Hepatol，2003，38（3）：266-272．DOI：10.1016/s0168-8278（02）00420-8.
［49］BOSCH J，GARCíA-PAGáN J C.Prevention of variceal rebleeding［J］．Lancet，2003，361（9361）：952-954．DOI：10.1016/S0140-6736（03）12778-X.
［50］VILLANUEVA C，COLOMO A，BOSCH A，et al．Transfusion strategies for acute upper gastrointestinal bleeding［J］．N Engl J Med，2013，368（1）：11-21．DOI：10.1056/NEJMoa1211801.
［51］VILLANUEVA C，ESCORSELL à.Optimizing general management of acute variceal bleeding in cirrhosis［J］．Curr Hepatology Rep，2014，13（3）：198-207．DOI：10.1007/s11901-014-0241-7.
［52］BERNARD B，GRANGé J D，KHAC E N，et al．Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding：a meta-analysis［J］．Hepatology，1999，29（6）：1655-1661．DOI：10.1002/hep.510290608.
［53］SORIANO G，CASTELLOTE J，ALVAREZ C，et al．Secondary bacterial peritonitis in cirrhosis：a retrospective study of clinical and analytical characteristics，diagnosis and management［J］．J Hepatol，2010，52（1）：39-44．DOI：10.1016/j.jhep.2009.10.012.
［54］KHWAJA A.KDIGO clinical practice guidelines for acute kidney injury［J］．Nephron Clin Pract，2012，120（4）：c179-184．DOI：10.1159/000339789.
［55］GARCIA-TSAO G，PARIKH C R，VIOLA A.Acute kidney injury in cirrhosis［J］．Hepatology，2008，48（6）：2064-2077．DOI：10.1002/hep.22605.
［56］MOREAU R，LEBREC D.Diagnosis and treatment of acute renal failure in patients with cirrhosis［J］．Best Pract Res Clin Gastroenterol，2007，21（1）：111-123．DOI：10.1016/j.bpg.2006.10.004.
［57］MOREAU R，LEBREC D.Acute renal failure in patients with cirrhosis：perspectives in the age of MELD［J］．Hepatology，2003，37（2）：233-243．DOI：10.1053/jhep.2003.50084.
［58］MOREAU R，DURAND F，POYNARD T，et al．Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome：a retrospective multicenter study［J］．Gastroenterology，2002，122（4）：923-930．DOI：10.1053/gast.2002.32364.
［59］SANYAL A J，BOYER T，GARCIA-TSAO G，et al．A randomized，prospective，double-blind，placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome［J］．Gastroenterology，2008，134（5）：1360-1368．DOI：10.1053/j.gastro.2008.02.014.
［60］BOYER T D，SANYAL A J，WONG F，et al．Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1［J］．Gastroenterology，2016，150（7）：1579-1589.e2．DOI：10.1053/j.gastro.2016.02.026.
［61］RODRíGUEZ E，ELIA C，SOLà E，et al．Terlipressin and albumin for type-1 hepatorenal syndrome associated with Sepsis［J］．J Hepatol，2014，60（5）：955-961．DOI：10.1016/j.jhep.2013.12.032.
［62］SARIN S K，SHARMA P.Terlipressin：an asset for hepatologists!［J］．Hepatology，2011，54（2）：724-728．DOI：10.1002/hep.24519.
［63］王忠英，刘菲菲，刘畅，等．11例特利加压素不良反应分析与护理［J］．实用临床护理学电子杂志，2016（5）：141-142.http：//www.cnki.com.cn/Article/CJFDTotal-SLHL201605104.htm.
［64］苏娟娟，李儿，吴银凤.特利加压素治疗肝肾综合征引起腹泻22例的护理［J］．中国乡村医药，2012，19（11）：77．DOI：10.3969/j.issn.1006-5180.2012.11.054.http：//www.cnki.com.cn/Article/CJFDTotal-XCYY201211067.htm.
［65］CAVALLIN M，KAMATH P S，MERLI M，et al．Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome：a randomized trial［J］．Hepatology，2015，62（2）：567-574．DOI：10.1002/hep.27709.
［66］ARROYO V，JALAN R.Acute-on-chronic liver failure：definition，diagnosis，and clinical characteristics［J］．Semin Liver Dis，2016，36（2）：109-116．DOI：10.1055/s-0036-1583202.
［67］SARIN S K，KEDARISETTY C K，ABBAS Z，et al．Acute-on-chronic liver failure：consensus recommendations of the Asian Pacific Association for the Study of the Liver （APASL） 2014［J］．Hepatol Int，2014，8（4）：453-471．DOI：10.1007/s12072-014-9580-2.
［68］JALAN R，YURDAYDIN C，BAJAJ J S，et al．Toward an improved definition of acute-on-chronic liver failure［J］．Gastroenterology，2014，147（1）：4-10．DOI：10.1053/j.gastro.2014.05.005.
［69］BAJAJ J S.Defining acute-on-chronic liver failure：will East and West ever meet?［J］．Gastroenterology，2013，144（7）：1337-1339．DOI：10.1053/j.gastro.2013.04.024.
［70］KIM T Y，SONG D S，KIM H Y，et al．Characteristics and discrepancies in acute-on-chronic liver failure：need for a unified definition［J］．PLoS One，2016，11（1）：e0146745．DOI：10.1371/journal.pone.0146745.
［71］ARROYO V，MOREAU R，JALAN R，et al．Acute-on-chronic liver failure：a new syndrome that will re-classify cirrhosis［J］．J Hepatol，2015，62（1 Suppl）：S131-143．DOI：10.1016/j.jhep.2014.11.045.
［72］JALAN R，SALIBA F，PAVESI M，et al．Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure［J］．J Hepatol，2014，61（5）：1038-1047．DOI：10.1016/j.jhep.2014.06.012.
［73］DHIMAN R K，AGRAWAL S，GUPTA T，et al．Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome［J］．World J Gastroenterol，2014，20（40）：14934-14941．DOI：10.3748/wjg.v20.i40.14934.
［74］MCPHAIL M J，SHAWCROSS D L，ABELES R D，et al．Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system［J］．Clin Gastroenterol Hepatol，2015，13（7）：1353-1360.e8．DOI：10.1016/j.cgh.2014.08.041.
［75］中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南（2018年版）［J］．现代医药卫生，2018，34（24）：3897-3900.
［76］LEE M，LEE J H，OH S，et al．CLIF-SOFA scoring system accurately predicts short-term mortality in acutely decompensated patients with alcoholic cirrhosis：a retrospective analysis［J］．Liver Int，2015，35（1）：46-57．DOI：10.1111/liv.12683.
［77］MOREAU R，JALAN R，GINES P，et al．Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis［J］．Gastroenterology，2013，144（7）：1426-1437.e1-9．DOI：10.1053/j.gastro.2013.02.042.
［78］TREBICKA J.Predisposing factors in acute-on-chronic liver failure［J］．Semin Liver Dis，2016，36（2）：167-173．DOI：10.1055/s-0036-1583195.
［79］GARG H，SARIN S K，KUMAR M，et al．Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure［J］．Hepatology，2011，53（3）：774-780．DOI：10.1002/hep.24109.
［80］JOHNSON T M，OVERGARD E B，COHEN A E，et al．Nutrition assessment and management in advanced liver disease［J］．Nutr Clin Pract，2013，28（1）：15-29．DOI：10.1177/0884533612469027.
［81］MOSS O.Nutrition priorities：diet recommendations in liver cirrhosis［J］．Clin Liver Dis （Hoboken），2019，14（4）：146-148．DOI：10.1002/cld.831.
［82］COX-NORTH P.Issues in the end-stage liver disease patient for which palliative care could be helpful［J］．Clin Liver Dis （Hoboken），2015，6（2）：33-36．DOI：10.1002/cld.492.
［83］GUO Y J，TIAN Z B，JIANG N，et al．Effects of late evening snack on cirrhotic patients：a systematic review and meta-analysis［J］．Gastroenterol Res Pract，2018，2018：9189062．DOI：10.1155/2018/9189062.
［84］王丽.肝病治疗：医病更需医 “心” ［J］．肝博士，2015（4）：43-44.http：//www.cnki.com.cn/Article/CJFDTotal-GBSH201504016.htm.
［85］徐雪梅.研究心理护理干预对慢性肝病患者治疗效果及生存质量的影响［J］．智慧健康，2018，4（4）：191-192．DOI：10.19335/j.cnki.2096-1219.2018.04.86.
［86］乔趁心.慢性肝病患者的心理干预［J］．家庭医药，2019（6）：294-295.http：//d.old.wanfangdata.com.cn/Periodical/jtyy201906427.
［87］宁红梅.肝病患者更需要人文关怀［J］．当代医学，2011，17（24）：117-118．DOI：10.3969/j.issn.1009-4393.2011.24.083.http：//www.cnki.com.cn/Article/CJFDTotal-DDYI201124085.htm.
［88］任培吉，张静静，夏满琴，等．慢性乙型肝炎患者的护理需融入人文关怀［J］．江西医药，2005，40（12）：870-872．DOI：10.3969/j.issn.1006-2238.2005.12.057.http：//www.cnki.com.cn/Article/CJFDTotal-JXYY200512056.htm.
［89］赵琨.社区卫生服务重要性的定量研究［J］．中国卫生经济，2001，20（2）：36-37．DOI：10.3969/j.issn.1003-0743.2001.02.014.
［90］杜敏.浅谈社区医疗服务的重要性［J］．健康必读：下旬刊，2011（11）：413.http：//www.wanfangdata.com.cn/details/detail.do?_type=perio&id=jkbd-x201111583.
［91］孙文澜.全科医生在社区慢病管理中的重要性［J］．中医药管理杂志，2016，24（11）：171-172．DOI：10.16690/j.cnki.1007-9203.2016.11.081.http：//www.cnki.com.cn/Article/CJFDTotal-ZYYG201611110.htm.

[1]	YAO Yuzhong, MA Xiaojun, SONG Huan, ZHONG Yu. The Management Effect of Diabetes "1358 model" on Community Diabetes Patients Based on "Precision Management Combining General Care and Specialty Care" [J]. Chinese General Practice, 2023, 26(34): 4308-4314.
[2]	LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong. The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community [J]. Chinese General Practice, 2023, 26(34): 4296-4301.
[3]	LI Jingjing, YUAN Ding, WANG Xiuling, KANG Hongfei, LAI Chengcheng, WANG Peisong, LU Guangping, GAO Yanxia. Evaluation of the Application Effect of Virtual Reality Technology in Standardized Training of General Practice Residents [J]. Chinese General Practice, 2023, 26(34): 4322-4328.
[4]	GAO Dekang, WEI Shaohua, MA Xiaoming, DU Peng, XING Chungen, CAO Chun. Risk Factors for Loss of Skeletal Muscle Mass and Its Correlation with Complications after Major Hepatectomy for Liver Cancer [J]. Chinese General Practice, 2023, 26(32): 4031-4037.
[5]	ZHOU Yingda, ZHUO Shuxiong, YANG Xi, JIN Hua, YU Dehua. Implementation Status and Strategy Research on the Construction of Clinical Pathways for Diagnosis and Treatment of Medically Unexplained Disease in Community General Practice [J]. Chinese General Practice, 2023, 26(31): 3939-3944.
[6]	YU Dehua. Scientific Research Conception Guided by General Practice Thinking [J]. Chinese General Practice, 2023, 26(31): 3872-3876.
[7]	LOU Zheng, LIU Ying, REN Jingjing. Visits for Medically Unspecified Disease in General Internal Medicine Clinics of County General Hospitals [J]. Chinese General Practice, 2023, 26(31): 3945-3950.
[8]	WANG Jiaxin, ZHAO Yali. Domestic and International Assessment Tools for Medical Teamwork: a Systematic Review [J]. Chinese General Practice, 2023, 26(31): 3951-3962.
[9]	HONG Yuchun, WU Hua, DU Yishan, LI Shuran, SUN Wenmin, YE Mingyu, ZHANG Yongjian, LI Yang. Development of General Practice Diagnostic Terminology and Coding and Empirical Study on Its Application [J]. Chinese General Practice, 2023, 26(31): 3896-3901.
[10]	LI Fangjian, JI Zequan, YE Huiling, YAN Ping, CHEN Dexiong, ZHANG Kouxing, LIANG Xiang, WANG Jiaji, HU Bingjie. The Development History and Current Situation of General Practice Education in Guangdong Province in the Past 30 Years [J]. Chinese General Practice, 2023, 26(31): 3915-3921.
[11]	GAO Yanli, WANG Hongjun, SUN Fei, JI Xiangqin, Changizi Roohollah. Exploration of Chronic Disease Management Model in Secondary Private General Hospital [J]. Chinese General Practice, 2023, 26(28): 3585-3590.
[12]	YIN Zhaoxia, LIU Caiyun, ZHANG Baoshuang, CHEN Yanli, GONG Weijie. Current Situation of Cognition and Formulation of Faculty Teaching Objectives in Standardized Training for Residency Practitioners: a Qualitative Study [J]. Chinese General Practice, 2023, 26(28): 3533-3538.
[13]	WANG Qianqian, WANG Xiaohang, ZHOU Xiaoying, QIU Shanhu, SUN Zilin. Exercise is the Foundation of Weight Loss [J]. Chinese General Practice, 2023, 26(28): 3471-3476.
[14]	LI Bing, YANG Shan, WANG Cong, CHEN Jinjing, XU Zhiwei, LIU Xiaoyu, WANG Liuyi. Perceptions toward General Practice Career among Non-targeted Admission General Medical Graduates Completing the Standardized General Residency Training Program [J]. Chinese General Practice, 2023, 26(28): 3544-3550.
[15]	DONG Yanan, JIANG Xiaorui, WANG Kai, ZONG Chuanchong, LIN Guodong, LI Xiangqing, LIN Chunxiao, CHI Juntao. The Effect of Modified Tibial Transverse Transport Technique in the Treatment of Wagner Grade Ⅲ and Ⅳ Diabetic Foot Patients [J]. Chinese General Practice, 2023, 26(27): 3411-3416.