Department of Hepatology, Division of GI Sciences, Christian Medical College, Vellore, India.
Department of Pathology, Division of GI Sciences, Christian Medical College, Vellore, India.
Indian J Med Res. 2019 Apr;149(4):468-478. doi: 10.4103/ijmr.IJMR_1405_17.
In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.
在印度，大多数非肝硬化性肝内门静脉高压（NCIPH）患者都存在一种不明原因的肠病。小肠细菌污染和热带性肠病可能会引发炎症刺激，并激活门脉系统中的内皮细胞。受砷污染的地下水是印度大片地区流行的环境因素，具有类似的后果。由活化的内皮细胞表达的血管性血友病因子（一种粘性蛋白）可能会促进血小板微血栓的形成，并阻塞导致 NCIPH 的肝内门静脉分支。与卫生条件不佳有关的环境因素通过胃肠道（GI）进入，易使血小板黏附到门脉微循环中活化的内皮细胞上。因此，NCIPH 作为与贫困相关的血栓形成倾向的一个例子，主要影响印度人口中社会经济地位较低的阶层。迫切需要改善卫生条件、提供清洁饮用水和消除饮用水砷污染等公共卫生措施。在解决这些环境因素之前，NCIPH 可能仍然是“印度病”。
