Lightsey Joseph M, Rockey Don C
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Curr Opin Gastroenterol. 2017 May;33(3):158-163. doi: 10.1097/MOG.0000000000000355.
The current review seeks to define ischemic hepatitis and its associated comorbidities. It means to review the pathophysiology, clinical presentation, clinical course, outcomes, and any potential therapies.
Ischemic hepatitis has long been associated with cardiovascular disease; recent reports have found a substantial link between preexisting cardiovascular disease and the risk for developing ischemic hepatitis. A proposed mechanism by which hepatic congestion predisposes the liver to hemodynamic injury further defines this link. Treatment is aimed at the underlying hemodynamic disturbance; however, efforts to better predict mortality and improve outcomes continue to arise. The Acute Liver Failure Study Group proposed that, though uncommon, ischemic hepatitis may result in acute liver failure. With numerous studies identifying the multiple comorbid conditions associated with ischemic hepatitis, the sequela of acute liver failure is called into question.
Ischemic hepatitis is a clinical syndrome frequently encountered in critically ill patients that represents a complication of underlying cardiac, circulatory, or respiratory failure. The pathogenesis of ischemic hepatitis appears to occur as a result of a 'two-hit' mechanism when the liver, which is at risk, is subsequently exposed to systemic hypoperfusion and ischemia, ultimately resulting in a marked but transient elevation in aspartate aminotransferase and alanine aminotransferase. Mortality is high and is dependent largely on the underlying cause of hypotension. Treatment is directed at the underlying cause of hemodynamic disturbance.
本综述旨在明确缺血性肝炎及其相关合并症。旨在回顾其病理生理学、临床表现、临床病程、预后及任何潜在治疗方法。
长期以来，缺血性肝炎一直与心血管疾病相关；近期报告发现，既往存在的心血管疾病与发生缺血性肝炎的风险之间存在显著关联。肝淤血使肝脏易发生血流动力学损伤的一种推测机制进一步明确了这种联系。治疗旨在针对潜在的血流动力学紊乱；然而，更好地预测死亡率和改善预后的努力仍在不断涌现。急性肝衰竭研究组提出，尽管缺血性肝炎并不常见，但可能导致急性肝衰竭。随着众多研究确定了与缺血性肝炎相关的多种合并症，急性肝衰竭的后遗症受到质疑。
缺血性肝炎是危重症患者中常见的临床综合征，是潜在心脏、循环或呼吸衰竭的并发症。缺血性肝炎的发病机制似乎是由于“双重打击”机制，即处于风险中的肝脏随后受到全身低灌注和缺血影响，最终导致天冬氨酸转氨酶和丙氨酸转氨酶显著但短暂升高。死亡率很高，主要取决于低血压的潜在病因。治疗针对血流动力学紊乱的潜在病因。
