Lange Christian M, Moreau Richard
Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, Germany.
Centre de Recherche sur l'Inflammation (CRI), Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Paris, France.
Visc Med. 2018 Aug;34(4):276-282. doi: 10.1159/000488690. Epub 2018 Jul 3.
Increasing evidence reveals a close and reciprocal link between acute-on-chronic liver failure (ACLF) and immunodysfunction.
A literature search in PubMed and abstract databases of relevant congresses was performed.
Important characteristics of liver cirrhosis like tissue hypoxia, cell death, or bacterial translocation maintain a state of chronic inflammation. Precipitating events of ACLF such as infections or alcoholic hepatitis are capable of strongly augmenting cirrhosis-associated systemic inflammation to grades sufficient to induce ACLF-defining organ failures. Chronic systemic inflammation, however, is causally linked to profound immunosuppression. As a consequence, patients with liver cirrhosis and in particular with ACLF are at high risk for severe infections. Promising strategies to ameliorate immunodysfunction, like albumin substitution, administration of recombinant interleukin-22 or granulocyte colony-stimulating factor, antibiotic prophylaxis, or anticoagulation, are under development and offer the chance to specifically prevent and treat ACLF.
A better understanding of the immunopathology of ACLF will likely translate into the implementation of specific therapeutic modalities to prevent and overcome ACLF.
越来越多的证据表明，慢加急性肝衰竭（ACLF）与免疫功能障碍之间存在密切且相互的联系。
在PubMed及相关大会的摘要数据库中进行文献检索。
肝硬化的重要特征，如组织缺氧、细胞死亡或细菌易位，维持着慢性炎症状态。ACLF的诱发事件，如感染或酒精性肝炎，能够强烈加剧与肝硬化相关的全身炎症，使其程度足以引发定义ACLF的器官功能衰竭。然而，慢性全身炎症与严重的免疫抑制存在因果联系。因此，肝硬化患者尤其是ACLF患者发生严重感染的风险很高。改善免疫功能障碍的有前景的策略，如白蛋白替代、重组白细胞介素-22或粒细胞集落刺激因子的给药、抗生素预防或抗凝治疗，正在研发中，为特异性预防和治疗ACLF提供了机会。
更好地理解ACLF的免疫病理学可能会转化为实施特异性治疗方法以预防和克服ACLF。
