Noor Mohd Talha, Manoria Piyush
Department of Gastroenterology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, India.
J Clin Transl Hepatol. 2017 Mar 28;5(1):50-58. doi: 10.14218/JCTH.2016.00056. Epub 2017 Mar 10.
Cirrhosis due to any etiology disrupts the homeostatic role of liver in the body. Cirrhosis-associated immune dysfunction leads to alterations in both innate and acquired immunity, due to defects in the local immunity of liver as well as in systemic immunity. Cirrhosis-associated immune dysfunction is a dynamic phenomenon, comprised of both increased systemic inflammation and immunodeficiency, and is responsible for 30% mortality. It also plays an important role in acute as well as chronic decompensation. Immune paralysis can accompany it, which is characterized by increase in anti-inflammatory cytokines and suppression of proinflammatory cytokines. There is also presence of increased gut permeability, reduced gut motility and altered gut flora, all of which leads to increased bacterial translocation. This increased bacterial translocation and consequent endotoxemia leads to increased blood stream bacterial infections that cause systemic inflammatory response syndrome, sepsis, multiorgan failure and death. The gut microbiota of cirrhotic patients has more pathogenic microbes than that of non-cirrhotic individuals, and this disturbs the homeostasis and favors gut translocation. Prompt diagnosis and treatment of such infections are necessary for better survival. We have reviewed the various mechanisms of immune dysfunction and its consequences in cirrhosis. Recognizing the exact pathophysiology of immune dysfunction will help treating clinicians in avoiding its complications in their patients and can lead to newer therapeutic interventions and reducing the morbidity and mortality rates.
任何病因引起的肝硬化都会破坏肝脏在体内的稳态作用。肝硬化相关的免疫功能障碍会导致先天性免疫和获得性免疫的改变，这是由于肝脏局部免疫以及全身免疫存在缺陷所致。肝硬化相关的免疫功能障碍是一种动态现象，包括全身炎症增加和免疫缺陷，其导致的死亡率为30%。它在急性和慢性失代偿中也起重要作用。免疫麻痹可能伴随出现，其特征是抗炎细胞因子增加和促炎细胞因子受到抑制。还存在肠道通透性增加、肠道蠕动减弱和肠道菌群改变的情况，所有这些都会导致细菌移位增加。这种细菌移位增加以及随之而来的内毒素血症会导致血流细菌感染增加，进而引起全身炎症反应综合征、脓毒症、多器官功能衰竭和死亡。肝硬化患者的肠道微生物群比非肝硬化个体含有更多的致病微生物，这会扰乱体内稳态并有利于肠道移位。及时诊断和治疗此类感染对于提高生存率至关重要。我们回顾了肝硬化中免疫功能障碍的各种机制及其后果。认识到免疫功能障碍的确切病理生理学将有助于临床治疗医生避免其患者出现并发症，并可能带来新的治疗干预措施，降低发病率和死亡率。
