O'Beirne James, Holmes Michael, Agarwal Banwari, Bouloux Pierre, Shaw Steve, Patch David, Burroughs Andrew
Department of Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond Street, Hampstead, London, UK.
J Hepatol. 2007 Sep;47(3):418-23. doi: 10.1016/j.jhep.2007.06.008. Epub 2007 Jun 28.
Recently, treatment with corticosteroids in the setting of septic shock and adrenal insufficiency has been shown to decrease mortality. In septic patients, a blunted response to adrenal stimulation identifies patients with a poorer prognosis who may benefit from corticosteroid supplementation. This condition has been termed relative adrenal insufficiency (RAI). Given the similarities between septic shock and liver failure, a number of groups have now studied the incidence of RAI in various forms of liver disease. Although different definitions of RAI exist, the current literature suggests that RAI is common, being seen in 33% of acute liver failure patients and up to 65% of patients with chronic liver disease and sepsis. The finding that RAI can exist in the absence of sepsis and may be as high as 92% of patients undergoing liver transplantation using a steroid free protocol has led one group to propose the term hepatoadrenal syndrome. The purpose of this review is to summarise the existing evidence for adrenal insufficiency in liver disease, to examine the possibility that adrenal dysfunction in liver disease may have a separate pathogenesis to that observed in sepsis and to provide insight into the potential areas for further research into this condition.
最近，已证明在感染性休克和肾上腺功能不全的情况下使用皮质类固醇进行治疗可降低死亡率。在脓毒症患者中，对肾上腺刺激反应迟钝表明患者预后较差，可能受益于补充皮质类固醇。这种情况被称为相对肾上腺功能不全（RAI）。鉴于感染性休克和肝衰竭之间存在相似性，现在有许多研究小组对各种肝病中RAI的发生率进行了研究。尽管存在不同的RAI定义，但目前的文献表明RAI很常见，在33%的急性肝衰竭患者以及高达65%的慢性肝病合并脓毒症患者中可见。RAI可在无脓毒症的情况下存在，并且在采用无类固醇方案进行肝移植的患者中可能高达92%，这一发现促使一个研究小组提出了“肝肾上腺综合征”这一术语。本综述的目的是总结肝病中肾上腺功能不全的现有证据，探讨肝病中肾上腺功能障碍可能具有与脓毒症中观察到的不同发病机制的可能性，并深入了解该病症进一步研究的潜在领域。
