Pár Alajos, Pár Gabriella
Pécsi Tudományegyetem, Altalános Orvostudományi Kar, I. Belgyógyászati Klinika, Pécs.
Orv Hetil. 2005 Jan 2;146(1):3-13.
The extracellular matrix deposition in the liver parenchyma is a major component of cirrhosis. A great deal of knowledge has been gathered in the past two decades regarding the regulation and dynamics of fibrogenesis, and based on these advances, a review is delivered on the pathophysiology, diagnosis and therapy of liver fibrosis. The key event in fibrogenesis is the activation of hepatic stellate cells, and in its mechanism, inflammation, oxidative stress, steatosis, cytokines, growth factors, enzymes and enzyme inhibitors play a pivotal role. The phenotypic response of activated stellate cells comprises proliferation, fibrogenesis, contractility, loss of vitamin A and matrix degradation. In the diagnosis of liver fibrosis, besides liver biopsy--as "golden standard"--recently non-invasive methods, such as imaging techniques, and mainly serum fibrosis markers and indices have widely been studied. Experimental and clinical data have proved the reversibility of fibrosis, and suggested that an effective antifibrotic treatment in the future may serve even for the prevention of cirrhosis.
肝实质中的细胞外基质沉积是肝硬化的主要组成部分。在过去二十年里，人们已经积累了大量关于纤维化形成的调控和动态变化的知识，基于这些进展，本文对肝纤维化的病理生理学、诊断和治疗进行综述。纤维化形成的关键事件是肝星状细胞的激活，在其机制中，炎症、氧化应激、脂肪变性、细胞因子、生长因子、酶和酶抑制剂起着关键作用。激活的星状细胞的表型反应包括增殖、纤维化形成、收缩性、维生素A丢失和基质降解。在肝纤维化的诊断中，除了作为“金标准”的肝活检外，近年来非侵入性方法，如图像技术，主要是血清纤维化标志物和指标，得到了广泛研究。实验和临床数据已经证明了纤维化的可逆性，并表明未来有效的抗纤维化治疗甚至可能用于预防肝硬化。
