Sekamova S M, Beketova T P
Arkh Patol. 1985;47(12):3-13.
The authors' and literature data on the liver changes at different types of shock are summarized with consideration of the role of etiology and pathogenetic factors. Three groups of similar liver alterations reflecting the severity of impairment of the reticulo-endothelial system (RES), microcirculation and parenchyma are distinguished. No clear-cut dependence between the liver morphological changes and the severity of shock is noted. At the same time the characteristic structural alterations for some forms of shock differing at their early stages by a predominance of neuro-reflectoral, hypovolemic or toxic component are revealed. A rapidly developing hydropic degeneration, the absence of the compensatory changes, signs of the RES deficiency with the progressing necrobiotic and necrotic processes in the liver are characteristic for a neuro-reflectoral shock. Endotoxic shock is associated with widespread intravascular thrombi, liver cell necrosis, combination of the destruction of reticuloendotheliocytes with the signs of their preceding activation, foci of a smooth cytoplasmic network hyperplasia of centrolobular hepatocytes; hypovolemic shock is characterized by activation of compensatory processes.
作者及文献中关于不同类型休克时肝脏变化的数据在考虑病因和发病因素作用的情况下进行了总结。区分出反映网状内皮系统(RES)、微循环和实质损害严重程度的三组相似的肝脏改变。未观察到肝脏形态学变化与休克严重程度之间存在明确的相关性。同时,揭示了某些形式休克在早期以神经反射性、低血容量性或毒性成分占优势而有所不同的特征性结构改变。神经反射性休克的特征是迅速发展的水样变性、缺乏代偿性变化、RES缺乏的迹象以及肝脏中进行性坏死和坏死过程。内毒素休克与广泛的血管内血栓形成、肝细胞坏死、网状内皮细胞破坏与其先前激活迹象的组合、小叶中央肝细胞光滑细胞质网络增生灶有关;低血容量性休克的特征是代偿过程的激活。