Fukui Hiroshi
Hiroshi Fukui, Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan.
World J Hepatol. 2015 Mar 27;7(3):425-42. doi: 10.4254/wjh.v7.i3.425.
A "leaky gut" may be the cutting edge for the passage of toxins, antigens or bacteria into the body, and may play a pathogenic role in advanced liver cirrhosis and its complications. Plasma endotoxin levels have been admitted as a surrogate marker of bacterial translocation and close relations of endotoxemia to hyperdynamic circulation, portal hypertension, renal, cardiac, pulmonary and coagulation disturbances have been reported. Bacterial overgrowth, increased intestinal permeability, failure to inactivate endotoxin, activated innate immunity are all likely to play a role in the pathological states of bacterial translocation. Therapeutic approach by management of the gut-liver axis by antibiotics, probiotics, synbiotics, prebiotics and their combinations may improve the clinical course of cirrhotic patients. Special concern should be paid on anti-endotoxin treatment. Adequate management of the gut-liver axis may be effective for prevention of liver cirrhosis itself by inhibiting the progression of fibrosis.
“肠漏”可能是毒素、抗原或细菌进入体内的前沿因素，并且可能在晚期肝硬化及其并发症中发挥致病作用。血浆内毒素水平已被公认为细菌移位的替代标志物，并且已有报道称内毒素血症与高动力循环、门静脉高压、肾脏、心脏、肺部和凝血功能障碍密切相关。细菌过度生长、肠道通透性增加、内毒素灭活失败、先天性免疫激活都可能在细菌移位的病理状态中起作用。通过使用抗生素、益生菌、合生元、益生元及其组合来管理肠肝轴的治疗方法可能会改善肝硬化患者的临床病程。应特别关注抗内毒素治疗。通过抑制纤维化进展，对肠肝轴进行充分管理可能对预防肝硬化本身有效。
