U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Department of Internal and Specialty Medicine, Azienda Ospedaliera Universitaria, Università degli Studi della Campania "Luigi Vanvitelli", Naples 80138, Italy.
IRCCS SDN, Naples, Italy.
Hepatobiliary Pancreat Dis Int. 2018 Aug;17(4):290-300. doi: 10.1016/j.hbpd.2018.06.004. Epub 2018 Jun 27.
Patients with end-stage liver disease (ESLD) have a compromised nutritional status because of the liver crucial role in regulating metabolic homeostasis and energy balance.
A systematic review of literature based on extensive relevant articles published from 2001 to 2017 in English in PubMed database was performed by searching keywords such as liver disease, non-alcoholic liver disease, alcoholic liver disease, malnutrition, epigenetics, gut microbiota, and probiotics.
Liver transplantation would be one eligible therapy for ESLD patients, even if, the clinical outcome is negatively influenced by malnutrition and/or infections. The malnutrition is a condition of nutrient imbalance with a high incidence in ESLD patients. An accurate evaluation of nutritional status could be fundamental for reducing complications and prolonging the survival of ESLD patients including those undergoing liver transplantation. In addition, the interaction among nutrients, diet and genes via epigenetics has emerged as a potential target to reduce the morbidity and mortality in ESLD patients. The malnutrition induces changes in gut microbiota causing dysbiosis with a probable translocation of bacteria and/or pathogen-derived factors from the intestine to the liver. Gut microbiota contribute to the progression of chronic liver diseases as well as hepatocellular carcinoma. The administration of probiotics modulating gut microbiota could improve all chronic liver diseases.
This review provides an update on malnutrition status linked to epigenetics and the potential benefit of some probiotics on the management of ESLD patients. In support of this view and to reveal the constant and growing interest in this field, some clinical trials are reported.
终末期肝病 (ESLD) 患者的营养状况受损，因为肝脏在调节代谢稳态和能量平衡方面起着关键作用。
通过在 PubMed 数据库中搜索关键词，如肝病、非酒精性肝病、酒精性肝病、营养不良、表观遗传学、肠道微生物群和益生菌，对 2001 年至 2017 年发表的英文相关文章进行了系统的文献综述。
肝移植将是 ESLD 患者的一种合格治疗方法，即使营养不良和/或感染会对临床结果产生负面影响。营养不良是一种营养失衡的状态，在 ESLD 患者中发病率很高。对营养状况进行准确评估对于减少并发症和延长 ESLD 患者（包括接受肝移植的患者）的生存至关重要。此外，通过表观遗传学，营养素、饮食和基因之间的相互作用已经成为降低 ESLD 患者发病率和死亡率的潜在目标。营养不良会导致肠道微生物群发生变化，导致菌群失调，细菌和/或病原体衍生因子可能从肠道转移到肝脏。肠道微生物群会导致慢性肝病和肝细胞癌的进展。益生菌可以调节肠道微生物群，从而改善所有慢性肝病。
本文综述了与表观遗传学相关的营养不良状况以及一些益生菌对 ESLD 患者管理的潜在益处。为了支持这一观点，并揭示人们对这一领域的持续关注，本文还报道了一些临床试验。
