Division of Surgery, Medical University of Graz, Graz, Austria.
Wien Klin Wochenschr. 2009;121(23-24):732-44. doi: 10.1007/s00508-009-1288-2.
Liver cirrhosis is a common disease causing great public-health concern because of the frequent complications requiring hospital care. Acute liver failure is also prone to several complications but is rare. One of the main complications for both acute and chronic liver diseases is infection, which regularly causes decompensation of cirrhosis, possibly leading to organ failure and death. This review focuses on innate immune function in cirrhosis, acute-on-chronic liver failure and acute liver failure. The known defects of Kupffer cells, neutrophils and monocytes are discussed, together with the pathophysiological importance of gut permeability, portal hypertension and intrinsic cellular defects, and the role of endotoxin, albumin, lipoproteins and toll-like receptors. Based on these different pathomechanisms, the available information on therapeutic strategies is presented. Antibiotic and probiotic treatment, nutritional support, artificial liver support, and experimental strategies such as inhibition of toll-like receptors and use of albumin and colony-stimulating factors are highlighted.
肝硬化是一种常见疾病，由于经常发生需要住院治疗的并发症，因此引起了公众的极大关注。急性肝功能衰竭也容易发生多种并发症，但较为罕见。急性和慢性肝病的主要并发症之一是感染，这经常导致肝硬化失代偿，可能导致器官衰竭和死亡。本综述重点介绍肝硬化、慢加急性肝衰竭和急性肝衰竭中的固有免疫功能。讨论了已知的库普弗细胞、中性粒细胞和单核细胞的缺陷，以及肠道通透性、门脉高压和内在细胞缺陷的病理生理学重要性，以及内毒素、白蛋白、脂蛋白和 Toll 样受体的作用。基于这些不同的发病机制，介绍了现有的治疗策略信息。强调了抗生素和益生菌治疗、营养支持、人工肝支持以及抑制 Toll 样受体和使用白蛋白和集落刺激因子等实验策略。
