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人类肝硬化中的炎症状态

Inflammatory status in human hepatic cirrhosis.

作者信息

Martínez-Esparza María, Tristán-Manzano María, Ruiz-Alcaraz Antonio J, García-Peñarrubia Pilar

机构信息

María Martínez-Esparza, María Tristán-Manzano, Antonio J Ruiz-Alcaraz, Pilar García-Peñarrubia, Departamento de Bioquímica, Biología Molecular (B) e Inmunología, Facultad de Medicina, IMIB, Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain.

出版信息

World J Gastroenterol. 2015 Nov 7;21(41):11522-41. doi: 10.3748/wjg.v21.i41.11522.

Abstract

This review focuses on new findings about the inflammatory status involved in the development of human liver cirrhosis induced by the two main causes, hepatitis C virus (HCV) infection and chronic alcohol abuse, avoiding results obtained from animal models. When liver is faced to a persistent and/or intense local damage the maintained inflammatory response gives rise to a progressive replacement of normal hepatic tissue by non-functional fibrotic scar. The imbalance between tissue regeneration and fibrosis will determine the outcome toward health recovery or hepatic cirrhosis. In all cases progression toward liver cirrhosis is caused by a dysregulation of mechanisms that govern the balance between activation/homeostasis of the immune system. Detecting differences between the inflammatory status in HCV-induced vs alcohol-induced cirrhosis could be useful to identify specific targets for preventive and therapeutic intervention in each case. Thus, although survival of patients with alcoholic cirrhosis seems to be similar to that of patients with HCV-related cirrhosis (HCV-C), there are important differences in the altered cellular and molecular mechanisms implicated in the progression toward human liver cirrhosis. The predominant features of HCV-C are more related with those that allow viral evasion of the immune defenses, especially although not exclusively, inhibition of interferons secretion, natural killer cells activation and T cell-mediated cytotoxicity. On the contrary, the inflammatory status of alcohol-induced cirrhosis is determined by the combined effect of direct hepatotoxicity of ethanol metabolites and increases of the intestinal permeability, allowing bacteria and bacterial products translocation, into the portal circulation, mesenteric lymph nodes and peritoneal cavity. This phenomenon generates a stronger pro-inflammatory response compared with HCV-related cirrhosis. Hence, therapeutic intervention in HCV-related cirrhosis must be mainly focused to counteract HCV-immune system evasion, while in the case of alcohol-induced cirrhosis it must try to break the inflammatory loop established at the gut-mesenteric lymph nodes-peritoneal-systemic axis.

摘要

本综述聚焦于由丙型肝炎病毒(HCV)感染和慢性酒精滥用这两个主要原因所致人类肝硬化发展过程中炎症状态的新发现,避免采用动物模型获得的结果。当肝脏面临持续性和/或强烈的局部损伤时,持续的炎症反应会导致正常肝组织逐渐被无功能的纤维化瘢痕所取代。组织再生与纤维化之间的失衡将决定健康恢复或肝硬化的结局。在所有情况下,向肝硬化的进展都是由调节免疫系统激活/稳态平衡的机制失调所引起的。检测HCV诱导的肝硬化与酒精诱导的肝硬化在炎症状态上的差异,有助于针对每种情况确定预防和治疗干预的特定靶点。因此,尽管酒精性肝硬化患者的生存率似乎与HCV相关性肝硬化(HCV-C)患者相似,但在向人类肝硬化进展过程中涉及的细胞和分子机制改变方面存在重要差异。HCV-C的主要特征更多地与那些使病毒逃避免疫防御的特征相关,特别是(但不仅限于)抑制干扰素分泌、自然杀伤细胞激活和T细胞介导的细胞毒性。相反,酒精性肝硬化的炎症状态是由乙醇代谢产物的直接肝毒性以及肠道通透性增加的综合作用所决定的,这使得细菌和细菌产物易位至门静脉循环、肠系膜淋巴结和腹腔。与HCV相关性肝硬化相比,这种现象会产生更强的促炎反应。因此,对HCV相关性肝硬化的治疗干预必须主要集中于对抗HCV对免疫系统的逃避,而对于酒精性肝硬化,则必须设法打破在肠道-肠系膜淋巴结-腹膜-全身轴建立的炎症循环。

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