Antoniades Charalambos Gustav, Berry Philip A, Wendon Julia A, Vergani Diego
Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
J Hepatol. 2008 Nov;49(5):845-61. doi: 10.1016/j.jhep.2008.08.009. Epub 2008 Aug 21.
Acute liver failure (ALF) shares striking similarities with septic shock with regard to the features of systemic inflammation, progression to multiple organ dysfunction and functional immunoparesis. While the existence of opposing systemic pro- and anti-inflammatory profiles resulting in organ failure and immune dysfunction are well recognised in septic shock, characterization of these processes in ALF has only recently been described. This review explores the evolution of the systemic inflammation in acute liver failure, its relation to disease progression, exacerbation of liver injury and development of innate immune dysfunction and extra-hepatic organ failure as sequelae. Defects in innate immunity are described in hepatic and extra-hepatic compartments. Clinical studies measuring levels of pro- and anti-inflammatory cytokines and expression of the antigen presentation molecule HLA-DR on monocytes, in combination with ex-vivo experiments, demonstrate that the persistence of a compensatory anti-inflammatory response syndrome, leading to functional monocyte deactivation, is a central event in the evolution of systemic immune dysfunction. Accurate immune profiling in ALF may permit the development of immunomodulatory strategies in order to improve outcome in this condition.
急性肝衰竭（ALF）在全身炎症特征、进展为多器官功能障碍和功能性免疫麻痹方面与感染性休克有着惊人的相似之处。虽然在感染性休克中，导致器官衰竭和免疫功能障碍的全身性促炎和抗炎反应特征的存在已得到充分认识，但急性肝衰竭中这些过程的特征直到最近才被描述。本综述探讨了急性肝衰竭中全身炎症的演变、其与疾病进展的关系、肝损伤的加重以及先天性免疫功能障碍和肝外器官衰竭作为后遗症的发展。先天性免疫缺陷在肝脏和肝外区域均有描述。临床研究测量促炎和抗炎细胞因子水平以及单核细胞上抗原呈递分子HLA-DR的表达，并结合体外实验表明，代偿性抗炎反应综合征的持续存在导致功能性单核细胞失活，是全身免疫功能障碍演变中的核心事件。对急性肝衰竭进行准确的免疫分析可能有助于制定免疫调节策略，以改善这种情况下的预后。
