Farinati F, De Bona M, Floreani A, Foschia F, Rugge M
Chair of Gastroenterology, University of Padova, Italy.
Ital J Gastroenterol Hepatol. 1998 Feb;30(1):124-8.
Helicobacter pylori infection is being correlated to a number of human diseases, among which also those of the liver. From a clinical point of view, 4 "areas of interest" for the suggested correlation can be identified: 1. Helicobacter pylori and portal hypertension-related congestive gastropathy in cirrhotics. There are, in the literature, at least 7 studies confirming that the microorganism has no role in causing or worsening the disease. 2. Helicobacter pylori and duodenal ulcer in cirrhotic patients. Apparently, in the cirrhotic patient, the microorganism has no role in causing duodenal ulcer. 3. Helicobacter pylori, ammonia production and hepatic encephalopathy. In this case, there are at least three studies showing that Helicobacter pylori infection increases the risk of developing encephalopathy in the cirrhotic patient, this being a somewhat expected finding. 4. Helicobacter pylori infection in chronic liver disease and its diagnosis. Evidence in the literature suggests: a) that hypertensive gastropathy might not represent a favourable environment for Helicobacter pylori thus making the diagnostic sensitivity of the biopsy lower than expected, and b) that even serological diagnosis might provide data of difficult interpretation, as shown in non alcoholic cirrhosis and, by our own group, in primary biliary cirrhosis. More intriguing are the data generated with respect to the potential capacity of Helicobacter pylori and Helicobacter pylori-like bacteria such as, in particular, Helicobacter hepaticus to damage the liver by producing toxins with a granulating effect on liver cell lines which, in vivo, through the portal tract, might reach the liver, thus causing hepatocellular damage. The point has been addressed by a number of investigators and autoimmune mechanisms have also been suggested. In summary, from the clinical point of view, some evidence suggests that Helicobacter pylori infection might be relevant in the pathogenesis of hepatic encephalopathy in cirrhosis. The data being generated with respect to a direct hepatotoxicity are, at present, stimulating but only speculative.
幽门螺杆菌感染与多种人类疾病相关，其中也包括肝脏疾病。从临床角度来看，可以确定与这种关联相关的4个“关注领域”：1. 幽门螺杆菌与肝硬化患者门静脉高压相关的充血性胃病。文献中至少有7项研究证实，该微生物在引发或加重该病方面不起作用。2. 幽门螺杆菌与肝硬化患者的十二指肠溃疡。显然，在肝硬化患者中，该微生物在引发十二指肠溃疡方面不起作用。3. 幽门螺杆菌、氨生成与肝性脑病。在这种情况下，至少有三项研究表明，幽门螺杆菌感染会增加肝硬化患者发生脑病的风险，这在某种程度上是一个意料之中的发现。4. 慢性肝病中的幽门螺杆菌感染及其诊断。文献证据表明：a）高血压性胃病可能并非幽门螺杆菌的适宜生存环境，因此活检的诊断敏感性低于预期；b）正如在非酒精性肝硬化以及我们自己的研究组在原发性胆汁性肝硬化中所显示的那样，即使是血清学诊断也可能提供难以解释的数据。关于幽门螺杆菌以及幽门螺杆菌样细菌（特别是肝螺杆菌）通过产生对肝细胞系有颗粒化作用的毒素来损害肝脏的潜在能力所产生的数据更具吸引力，这些毒素在体内可能通过门静脉到达肝脏，从而导致肝细胞损伤。许多研究人员都探讨过这一问题，也有人提出了自身免疫机制。总之，从临床角度来看，一些证据表明幽门螺杆菌感染可能与肝硬化肝性脑病的发病机制有关。目前，关于直接肝毒性所产生的数据虽令人振奋，但仅是推测性的。
