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肾素-血管紧张素-醛固酮系统抑制剂对肝纤维化和门静脉高压症的影响。

Impact of inhibitors of the Renin-Angiotensin-aldosterone system on liver fibrosis and portal hypertension.

作者信息

Töx U, Steffen H M

机构信息

Department of Gastroenterology and Hepatology, University Hospital, University of Cologne, Germany.

出版信息

Curr Med Chem. 2006;13(30):3649-61. doi: 10.2174/092986706779026138.

Abstract

Morbidity and mortality of chronic liver disease are primarily caused by liver cirrhosis and portal hypertension, both of them secondary disorders of progressive liver fibrosis. The main fibrogenic cell type in the liver, the hepatic stellate cell (HSC), is activated and stimulated by several factors, among which the renin-angiotensin-aldosterone system (RAAS) plays a major role. Angiotensin II induces various profibrotic pathways via the angiotensin II receptor type 1 (AT(1) receptor) not only in heart and kidney, but also in liver tissue. Stimulation of the AT(1) receptor promotes the transformation of the quiescent HSC into the myofibroblast like activated HSC and the synthesis of transforming growth factor-beta1 (TGF-beta), the major profibrotic cytokine in the liver. In addition, aldosterone has been suggested to induce profibrotic effects in chronic heart and liver disease. This review focuses on the concept that inhibitors of the RAAS retard or even reverse liver fibrosis and reduce portal hypertension. Angiotensin converting enzyme (ACE) inhibitors, AT(1) receptor antagonists, and aldosterone antagonists have been demonstrated to reduce the proliferation of HSC, to decrease the synthesis of profibrotic molecules, and to have the potential to improve liver fibrosis. However, side-effects such as systemic hypotension may impair the clinical application of RAAS inhibitors in patients with liver cirrhosis and portal hypertension. Also, efficacy may be limited by the downregulation of AT(1) receptors in advanced fibrosis, which has been observed in animal and human studies. Randomized clinical studies are essential to evaluate, whether this approach is beneficial in patients with chronic liver disease and progressive fibrosis.

摘要

慢性肝病的发病率和死亡率主要由肝硬化和门静脉高压引起,这两者都是进行性肝纤维化的继发性病症。肝脏中主要的促纤维化细胞类型,即肝星状细胞(HSC),会被多种因素激活和刺激,其中肾素 - 血管紧张素 - 醛固酮系统(RAAS)起主要作用。血管紧张素II不仅通过1型血管紧张素II受体(AT(1)受体)在心脏和肾脏中,还在肝脏组织中诱导各种促纤维化途径。对AT(1)受体的刺激促进静止的HSC转化为成肌纤维细胞样的活化HSC,并促进肝脏中主要的促纤维化细胞因子转化生长因子 - β1(TGF - β)的合成。此外,醛固酮已被认为在慢性心脏和肝脏疾病中诱导促纤维化作用。本综述重点关注RAAS抑制剂可延缓甚至逆转肝纤维化并降低门静脉高压这一概念。血管紧张素转换酶(ACE)抑制剂、AT(1)受体拮抗剂和醛固酮拮抗剂已被证明可减少HSC的增殖,减少促纤维化分子的合成,并有可能改善肝纤维化。然而,诸如全身性低血压等副作用可能会损害RAAS抑制剂在肝硬化和门静脉高压患者中的临床应用。此外,在动物和人体研究中已观察到,晚期纤维化中AT(1)受体的下调可能会限制疗效。随机临床研究对于评估这种方法对慢性肝病和进行性纤维化患者是否有益至关重要。

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