Shiomi S, Kuroki T, Ueda T, Takeda T, Nishiguchi S, Nakajima S, Kobayashi K, Ochi H, Yamagami S
Third Department of Internal Medicine, Osaka City University Medical School, Japan.
J Gastroenterol Hepatol. 1994 Mar-Apr;9(2):138-42. doi: 10.1111/j.1440-1746.1994.tb01233.x.
The reasons for the high frequency of endotoxaemia in cirrhosis, whether poor liver function or abnormal portal circulation, are not known. Accurate measurement of endotoxin itself is difficult. Instead, in this study an enzyme-linked immunosorbent assay was used to measure levels of IgA, IgG and IgM antibodies to endotoxin in patients with chronic liver disease and underlying hepatic viral infection. The relationships between the results and clinical symptoms or the presence of a portal systemic shunt were investigated. The median level of IgA antibodies was not different in patients with chronic hepatitis and those with cirrhosis, and the same was found for IgM, but the median level of IgG antibodies was significantly higher in the patients with cirrhosis. When patients with cirrhosis were grouped by the presence or absence of ascites or hepatocellular carcinoma, no significant difference was observed in any of these antibody levels. However, in cirrhotic patients with varices, the level of IgG antibodies to endotoxin was significantly higher than in patients without varices. For evaluation of the portal systemic shunt, the per-rectal portal shunt index was calculated. There was a significant correlation (R = 0.431, P < 0.001) between the per-rectal portal shunt index and the level of IgG antibodies to endotoxin. That is, the degree of abnormality in the portal haemodynamics was correlated with the level of IgG antibodies to endotoxin in patients with liver disease.
肝硬化患者内毒素血症高发的原因，无论是肝功能不佳还是门静脉循环异常，目前尚不清楚。内毒素本身的精确测量很困难。相反，在本研究中，采用酶联免疫吸附测定法来测量慢性肝病和潜在肝病毒感染患者中抗内毒素的IgA、IgG和IgM抗体水平。研究了这些结果与临床症状或门体分流存在之间的关系。慢性肝炎患者和肝硬化患者的IgA抗体中位水平无差异，IgM抗体情况相同，但肝硬化患者的IgG抗体中位水平显著更高。当根据有无腹水或肝细胞癌对肝硬化患者进行分组时，这些抗体水平均未观察到显著差异。然而，在有静脉曲张的肝硬化患者中，抗内毒素的IgG抗体水平显著高于无静脉曲张的患者。为评估门体分流，计算了经直肠门体分流指数。经直肠门体分流指数与抗内毒素的IgG抗体水平之间存在显著相关性（R = 0.431，P < 0.001）。也就是说，肝病患者门静脉血流动力学异常程度与抗内毒素的IgG抗体水平相关。
