肝硬化异常脾脏对肝脏病理生理功能的影响

江晓妮; 刘敏; 李强; 王玉平; 郭庆红; 关泉林; 周永宁

doi:10.3969/j.issn.1001-5256.2018.11.034

肝硬化异常脾脏对肝脏病理生理功能的影响

DOI: 10.3969/j.issn.1001-5256.2018.11.034

1. 兰州大学第一医院消化科
2. 兰州大学甘肃省胃肠病重点实验室
3. 兰州大学第一医院肿瘤外科

基金项目:

国家重点研发计划(2017YFC0908302,2016YFC0107006)；国家自然科学基金(81570783)；甘肃省自然科学基金(1606RJZA140,17JR5RA254,17JR5RA190)；兰州大学中央高校基本科研业务费专项资金(lzujbky-2018-kb15)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 1633
- HTML全文浏览量: 44
- PDF下载量: 347
- 被引次数: 0
出版历程
- 出版日期: 2018-11-20

Influence of abnormal spleen on liver pathophysiological function in patients with liver cirrhosis

Research funding:

摘要

摘要: 脾肿大是肝硬化门静脉高压较早出现的体征。由于肝硬化时脾静脉回流阻力增加,门静脉压力逆传至脾脏,使脾脏被动淤血性肿大,脾组织和脾内纤维组织增生。此外,肠道抗原物质经门-体侧支循环进入体循环,被脾脏摄取后抗原刺激脾单核-巨噬细胞增生,引发脾肿大、脾功能亢进。反之,异常脾脏也可以导致肝功能和门静脉血流动力学改变。因此,在肝硬化及其并发症的治疗过程中,对脾脏的干预是不容忽视的环节。综述了肝硬化过程中脾脏结构与功能异常对肝脏病理生理功能的影响。
- 肝硬化 /
- 高血压,门静脉 /
- 脾大 /
- 脾功能亢进 /
- 综述
Abstract: Splenomegaly is an early sign of cirrhotic portal hypertension. In patients with liver cirrhosis, the resistance of splenic venous reflux increases and portal venous pressure is reversed to the spleen, which causes congestive splenomegaly and hyperplasia of splenic tissue and fibrous tissue. In addition, intestinal antigens enter the systemic circulation via the portal-systemic collateral circulation and stimulates the proliferation of mononuclear macrophages in the spleen after being taken up by the spleen, which further leads to splenomegaly and hypersplenism. On the contrary, abnormal spleen can cause the changes in liver function and portal vein hemodynamics. Therefore, the intervention of the spleen cannot be neglected during the treatment of liver cirrhosis and its complications. This article reviews the influence of abnormal spleen structure and function on liver pathophysiological function in patients with liver cirrhosis.
- liver cirrhosis /
- hypertension, portal /
- splenomegaly /
- hypersplenism /
- review

HTML全文

参考文献(37)

[1] MCKENZIE CV, COLONNE CK, YEO JH, et al. Splenomegaly:Pathophysiological bases and therapeutic options[J]. Int J Biochem Cell B, 2018, 94:40-43.

[2] LI H, WANG GS. Research progress in hypersplenism after liver transplantation for liver cirrhosis[J]. Ogran Transplantation, 2016, 7 (3) :238-240. (in Chinese) 李慧, 汪根树.肝硬化肝移植术后脾功能亢进的研究进展[J].器官移植, 2016, 7 (3) :238-240.

[3] OKUDA K, KONG K, OHNISHI K, et al. Clinical study of eightysix caseins of idiopathic portal hypertension and comparison with cirrhosis with splenomegaly[J]. Gasteoenterology, 1984, 86:600-610.

[4] PRESSER N, QUONTINI C, TOM C, et al. Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients:A 5-year experience[J]. Liver Transplant, 2015, 21 (4) :435-441.

[5] LI YN, MIAO XY, QI HZ, et al. Splenic artery trunk embolization reduces the surgical risk of liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2015, 14 (3) :263-268.

[6] TSOCHATZIS EA, BOSCH J, BURROUGHS AK. Liver cirrhosis[J]. Lancet, 2014, 383 (9930) :1749-1761.

[7] VAIRAPPAN B. Endothelial dysfunction in cirrhosis:Role of inflammation and oxidative stress[J]. World J Hepatol, 2015, 7 (3) :443-459.

[8] BOLOGNESI M, PASCOLI MD, VERARDO A, et al. Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis[J].World J Gastroenterol, 2014, 20 (10) :2555-2563.

[9] NAGASUE N, DHAR DK, YAMANOI A, et al. Production and release of endothelin-1 from the gut and spleen in portal hypertension due to cirrhosis[J]. Hepatology, 2000, 31 (5) :1107-1114.

[10] MITCHELL O, FELDMAN DM, DIAKOW M, et al. The pathophysiology of thrombocytopenia in chronic liver disease[J]. Hepat Med, 2016, 8 (1) :39-50.

[11] HAYASHI H, BEPPU T, SHIRABE K, et al. Management of thrombocytopenia due to liver cirrhosis:A review[J]. World J Gastroenterol, 2014, 20 (10) :2595-2605.

[12] MASSOUD OI, ZEIN NN. The effect of transjugular intrahepatic portosystemic shunt on platelet counts in patients with liver cirrhosis[J].Gastroenterol Hepatol, 2017, 13 (5) :286-291.

[13] CHIEN CH, LIN YL, CHIEN RN, et al. Transient elastography for spleen stiffness measurement in patients with cirrhosis:Role in degree of thrombocytopenia[J]. J Ultras Med, 2016, 35 (9) :1849-1857.

[14] DUBOIS B, WILCOX C, WEINTRAUB J, et al. Efficacy and safety of partial splenic embolization in patients with splenomegaly associated cytopenias[J]. J Vasc Interv Radiol, 2017, 28 (2) :s69-s70.

[15] FEND B, ZHANG W, LUO BF, et al. Effect of spleen operation on antiviral treatment in hepatitis C virus-related cirrhotic patients[J].World J Gastroenterol, 2014, 20 (41) :15387-15397.

[16] PRIMIGNANI M. Portal vein thrombosis, revisited[J]. Digest Liver Dis, 2010, 42:163-170.

[17] QI XS, STEFANO VD. Anticoagulation for thetreatment of portal vein thrombosis in liver cirrhosis:A systematic review and meta-analysis of observational studies[J]. Eur J Intern Med, 2015, 26 (1) :23-29.

[18] PU YS, ZHANG S, ZHOU R, et al. IL-17A up-regulates expression of endothelial tissue factor in liver cirrhosis via the ROS/p38 signal pathway[J]. Biochem Biophys Res Commun, 2016, 470 (1) :41-47.

[19] ORLANDO R, LIRUSSI F, BASSO SM, et al. Splenomegaly as risk factor of liver cirrhosis. A retrospective cohort study of 2, 525patients who underwent laparoscopy[J]. Vivo, 2011, 25 (23) :1009-1012.

[20] WANG LF, SUN Y, ZHANG Z, et al. CXCR5+CD4+T follicular helper cells participate in the pathogenesis of primary biliary cirrhosis[J]. Hepatology, 2015, 61 (2) :627-638.

[21] LI L, DUAN M, CHEN W, et al. The spleen in liver cirrhosis:Revisiting an old enemy with novel targets[J]. J Transl Med, 2017, 15 (1) :111.

[22] ABOU-SHADY M, FRIESS H, ZIMMERMANN A, et al. Connective tissue growth factor in human liver cirrhosis[J]. Liver, 2000, 20 (4) :296-304.

[23] KUROKAWA T, OHKOHCHI N. Platelets in liver disease, cancer and regeneration[J]. World J Gastroenterol, 2017, 23 (18) :3228-3239.

[24] AKAHOSHI T, HASHIZUME M, TANOUE K, et al. Role of the spleen in liver ftbrosis in rats may be mediated by transforming growth factorβ-1[J]. J Gastroen Hepatol, 2002, 17 (1) :59-65.

[25] KONG DG, CHEN XL, LU SC, et al. Short-term effects of splenectomy on serum fibrosis indexes in liver cirrhosis patients[J]. Int J Clin Exp Pathol, 2015, 8 (11) :15260-15264.

[26] KWON YJ, LEE KG, CHOI D. Clinical implications of advances in liver regeneration[J]. Clin Mol Hepatol, 2015, 21 (1) :7-13.

[27] YAMADA S, MORINE Y, IMURA S, et al. Liver regeneration after splenectomy in patients with liver cirrhosis[J]. Hepatol Res, 2016, 46 (5) :443-449.

[28] MEYER J, LEJMI E, FONTANA P, et al. A focus on the role of platelets in liver regeneration:Do platelet-endothelial cell interactions initiate the regenerative process?[J]. J Hepatol, 2015, 63 (5) :1263-1271.

[29] STARLINGER P, ASSINGER A, GRUENBERGER T, et al. The role of platelets and portal venous pressure fluctuations in postoperative liver regeneration[J]. Eur Surg, 2015, 47 (6) :312-318.

[30] UEDA S, YAMANOI A, HISHIKAWA Y, et al. Transforming growth factor-β1 released from the spleen exerts a growth inhibitory effect on liver regeneration in rats[J]. Lab Invest, 2003, 83 (11) :1595-1603.

[31] CARRAPITA J, ARANTES AM, CAMPELOS S, et al. Impact of splenic artery ligation after major hepatectomy on liver function, regeneration and viability[J]. Sci Rep, 2016, 6:34731.

[32] LIU G, XIE C, FANG Y, et al. Splenectomy after partial hepatectomy accelerates liver regeneration in mice by promoting tight junction formation via polarity protein par 3-a PKC[J]. Life Sci, 2018, 192:91-98.

[33] YAMAMOTO N, OKANO K, OSHIMA M, et al. Laparoscopic splenectomy for patients with liver cirrhosis:Improvement of liver function in patients with child-pugh class B[J]. Surgery, 2015, 158 (6) :1538-1544.

[34] CHIN JL, CHAN G, RYAN JD, et al. Spleen stiffness can noninvasively assess resolution of portal hypertension after liver transplantation[J]. Liver Int, 2015, 35 (2) :518-523.

[35] WONG GLH, KWOK R, HUI AJ, et al. A new screening strategy for varices by liver and spleen stiffness measurement (LSSM) in cirrhotic patients:A randomized trial[J]. Liver Int, 2018, 38 (4) :636-644.

[36] SONG JY, DU GS, XIAO L, et al. Individualized immunosuppressive protocol of liver transplant recipient should be made based on splenic function status[J]. Chin Med J, 2016, 129 (11) :1340-1346.

[37] GAO XQ, ZHAO YX, REN X, et al. Research advances in druginduced autoimmune hepatitis[J]. J Clin Hepatol, 2017, 33 (11) :2222-2225. (in Chinese) 高晓琴, 赵永勋, 任茜, 等.药物诱导的自身免疫性肝炎的研究进展[J].临床肝胆病杂志, 2017, 33 (11) :2222-2225.

施引文献

资源附件(0)

访问统计