Department of Gastroenterology and Endocrinology, Georg-August-University Göttingen, Germany.
Ann Hepatol. 2010 Apr-Jun;9(2):133-43.
The liver is the largest parenchymatous organ of the body and central for intermediate metabolism. Its close contact to the portal blood streaming back from the gut and the systemic circulation is a prerequisite for the various processes ongoing on cellular level. The spatial relationship of the hepatocytes with the different cellular structures of the liver, such as fenestrated sinusoidal endothelial cells, Kupffer cells, and bile canaliculi is important for the organization and performance of the intermediate metabolism of nutrients (proteins, glucose and fatty acids), for the clearance of toxic or infectious agents, for metabolic detoxification and for the excretion of waste products. The administration of chemotherapy is a challenge for the tight regulation and balance of these processes. As most drugs tend to be lipophilic, they are readily taken up by the liver. Under chemotherapy, up to 85% of patients develop liver steatosis. Steatohepatitis is the more serious event, especially if accompanied by an increase in bilirubin levels. Modern understanding of the efficacy, safety and tolerability of combination chemotherapy has to increasingly include the individual context of a patient, such as age, gender, nutritional status, underlying diseases, genetic predisposition, as well as the cross-reactivity of the different drugs. This review tries to capture the various effects of chemotherapy on the liver, with a focus on chemotherapeutical compounds used for the treatment of gastrointestinal cancers.
肝脏是人体最大的实质器官，是中间代谢的中心。它与来自肠道的门静脉血液和全身循环的密切接触是细胞水平上各种进行中过程的前提。肝细胞与肝脏的不同细胞结构（如有孔的窦状内皮细胞、库普弗细胞和胆小管）的空间关系对于营养物质（蛋白质、葡萄糖和脂肪酸）的中间代谢、清除毒性或传染性物质、代谢解毒和废物排泄的组织和性能很重要。化疗的实施对这些过程的严格调节和平衡是一个挑战。由于大多数药物往往具有亲脂性，因此它们很容易被肝脏吸收。在化疗中，多达 85%的患者会出现肝脂肪变性。脂肪性肝炎是更严重的事件，特别是如果伴有胆红素水平升高。对联合化疗的疗效、安全性和耐受性的现代理解必须越来越多地包括患者的个体情况，如年龄、性别、营养状况、基础疾病、遗传易感性以及不同药物的交叉反应。本综述试图捕捉化疗对肝脏的各种影响，重点是用于治疗胃肠道癌症的化疗药物。
