Wellcome Trust Research Laboratory (Department of Gastrointestinal Sciences).
Department of Hepatology.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e329-e334. doi: 10.1097/MEG.0000000000002056.
Overactivation of reticuloendothelial cells lining liver sinusoids - Kupffer cells (macrophages) and sinusoidal endothelial cells - may narrow the sinusoidal lumen, impair perfusion in liver microcirculation and contribute to disease severity in alcoholic hepatitis.
The aim of the article was to assess reticuloendothelial activation in patients with severe alcoholic hepatitis (SAH).
In SAH patients, we prospectively studied baseline reticuloendothelial activation markers [serum ferritin, sCD163 and plasma von Willebrand factor (VWF) antigen] and Macrophage Activation Syndrome (MAS) criteria, correlated them with disease severity scores [model for end-stage liver disease (MELD) and Sequential Organ Failure Assessment (SOFA) scores] and analyzed their ability to predict survival over a 90-day follow-up period.
A total of 50 SAH patients [45 (37-49) years, median (interquartile range), 49 males, discriminant function, 76.2 (54.5-106.6); MELD score, 30 (26.2-36)] were studied. 41 SAH patients (82%) had ferritin >500 ng/mL, and all (100%) had markedly raised sCD163 and VWF levels. The median sCD163 level was 10-fold higher than healthy controls and the median VWF level was 5-fold above the upper limit of normal. In total, 37 SAH patients (74%) met MAS criteria. Reticuloendothelial activation markers correlated with MELD and SOFA scores (P < 0.05). VWF was an independent marker to predict mortality in SAH [adjusted hazard ratio, 1.002 (1.000-1.004)].
The reticuloendothelial system was markedly activated and correlated with disease severity scores in SAH patients.VWF predicted short-term mortality independent of MELD and sCD163. Further larger multicentric studies are needed to validate these findings.
肝窦内皮细胞（枯否细胞和窦状内皮细胞）的过度激活可能会使窦状腔变窄，损害肝微循环的灌注，并导致酒精性肝炎的疾病严重程度增加。
本文旨在评估严重酒精性肝炎（SAH）患者的网状内皮细胞激活情况。
我们前瞻性研究了 SAH 患者的基线网状内皮激活标志物[血清铁蛋白、sCD163 和血浆血管性血友病因子（VWF）抗原]和巨噬细胞活化综合征（MAS）标准，并将其与疾病严重程度评分[终末期肝病模型（MELD）和序贯器官衰竭评估（SOFA）评分]相关联，分析了它们在 90 天随访期间预测生存率的能力。
共研究了 50 例 SAH 患者[45（37-49）岁，中位数（四分位距），49 名男性，判别函数，76.2（54.5-106.6）；MELD 评分，30（26.2-36）]。41 例 SAH 患者（82%）铁蛋白>500ng/ml，所有患者（100%）sCD163 和 VWF 水平显著升高。sCD163 中位数水平是健康对照组的 10 倍，VWF 中位数水平是正常上限的 5 倍。共有 37 例 SAH 患者（74%）符合 MAS 标准。网状内皮激活标志物与 MELD 和 SOFA 评分相关（P<0.05）。VWF 是预测 SAH 患者死亡的独立标志物[调整后的危险比，1.002（1.000-1.004）]。
SAH 患者的网状内皮系统明显激活，并与疾病严重程度评分相关。VWF 独立于 MELD 和 sCD163 预测短期死亡率。需要进一步的更大规模的多中心研究来验证这些发现。
