Ueno M
Department of Internal Medicine, School of Medicine, Keio University.
Nihon Shokakibyo Gakkai Zasshi. 1990 Aug;87(8):1692-700.
This study was performed in order to elucidate the mechanisms of systemic endotoxemia in liver cirrhosis. For this purpose, the method of measuring biliary endotoxin was established. Endotoxin levels between in the bile and in the plasma in cirrhosis were compared using a modified method of chromogenic quantitative endotoxin assay in an attempt to clarify liver function of clearing portal endotoxin originated from the gut. And functional activities of the reticuloendothelial system were also examined by radioassay with 59Fe-labelled iron-chondroitin sulfate colloid and by enzymohistochemistry of acid phosphatase. Both the plasma and biliary endotoxin levels in liver cirrhosis were significantly higher, compared to those in control. The functional activities of the reticuloendothelial system, particularly of the Kupffer cells, were decreased in liver cirrhosis. These data provide evidence that in liver cirrhosis systemic endotoxemia is mainly due to a decrease of functional activities of Kupffer cells. On the other hand, the excretion of endotoxin into the bile is increased, compensating the decreased functional activities of Kupffer cells. This implies that the uptake of endotoxin and its excretion into the bile by hepatocytes might be one of the mechanisms of clearing excess endotoxin in the plasma in liver cirrhosis. This study also draws the importance of measurements of endotoxin levels in the bile in liver diseases.
本研究旨在阐明肝硬化时全身内毒素血症的机制。为此，建立了胆汁内毒素的检测方法。采用改良的显色定量内毒素检测方法，比较肝硬化患者胆汁和血浆中的内毒素水平，以阐明肝脏清除来自肠道的门静脉内毒素的功能。同时，通过用59Fe标记的硫酸软骨素铁胶体进行放射测定和酸性磷酸酶的酶组织化学，检测网状内皮系统的功能活性。与对照组相比，肝硬化患者血浆和胆汁中的内毒素水平均显著升高。肝硬化时网状内皮系统，尤其是库普弗细胞的功能活性降低。这些数据表明，肝硬化时全身内毒素血症主要是由于库普弗细胞功能活性降低所致。另一方面，内毒素向胆汁中的排泄增加，以补偿库普弗细胞功能活性的降低。这意味着肝细胞对内毒素的摄取及其向胆汁中的排泄可能是肝硬化时清除血浆中过量内毒素的机制之一。本研究还强调了在肝脏疾病中检测胆汁内毒素水平的重要性。
