Shenoda Botros, Boselli Joseph
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.
Drexel Internal Medicine, 205 N. Broad Street, Philadelphia, 19107, USA.
Clin J Gastroenterol. 2019 Oct;12(5):387-397. doi: 10.1007/s12328-019-00956-0. Epub 2019 Apr 12.
Liver cirrhosis is associated with multiple vascular syndromes affecting almost all body systems. Many of these syndromes are directly related to impaired liver function and sometimes reversible after liver transplantation while others arise secondary to portal hypertension and ascites. Altered expression of angiogenic and vasoactive compounds (most importantly nitric oxide), endothelial dysfunction, dysregulated neurohormonal control, and systemic inflammatory state play differential roles in mediating homeostatic instability and abnormal vasogenic response. Important vascular features encountered in liver disease include portal hypertension, splanchnic overflow, abnormal angiogenesis and shunts, portopulmonary syndrome, hepatopulmonary syndrome, and systemic hyperdynamic circulation. Redistribution of effective circulatory volume deviating from vital organs and pooling in splanchnic circulation is also encountered in liver patients which may lead to devastating outcomes as hepatorenal syndrome. Etiologically, vascular syndromes are not isolated phenomena and vascular dysfunction in one system may lead to the development of another in a different system. This review focuses on understanding the pathophysiological factors underlying vascular syndromes related to chronic liver disease and the potential links among them. Many of these syndromes are associated with high mortality, thus it is crucial to look for early biomarkers for these syndromes and develop novel preventive and therapeutic strategies.
肝硬化与多种血管综合征相关，这些综合征几乎影响身体的所有系统。其中许多综合征与肝功能受损直接相关，有时在肝移植后可逆转，而其他综合征则继发于门静脉高压和腹水。血管生成和血管活性化合物（最重要的是一氧化氮）表达改变、内皮功能障碍、神经激素控制失调以及全身炎症状态在介导体内稳态不稳定和异常血管生成反应中发挥着不同作用。肝病中遇到的重要血管特征包括门静脉高压、内脏血流增多、异常血管生成和分流、门肺综合征、肝肺综合征以及全身高动力循环。肝病患者还会出现有效循环血容量从重要器官重新分布并在内脏循环中积聚的情况，这可能导致诸如肝肾综合征等灾难性后果。从病因学角度来看，血管综合征并非孤立现象，一个系统的血管功能障碍可能导致另一个不同系统中血管综合征的发生。本综述着重于理解与慢性肝病相关的血管综合征背后的病理生理因素以及它们之间的潜在联系。这些综合征中的许多都与高死亡率相关，因此寻找这些综合征的早期生物标志物并制定新的预防和治疗策略至关重要。
