部分脾动脉栓塞治疗肝硬化脾功能亢进的作用机制
DOI: 10.3969/j.issn.1001-5256.2023.07.029
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:李宗伟负责文章撰写及修改;汪桠琴参与指导文章结构及内容修改;张跃伟负责提供写作思路,指导撰写文章及最后定稿。
The mechanism of action of partial splenic artery embolization in treatment of liver cirrhosis and hypersplenism
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摘要: 脾功能亢进(脾亢)是由肝硬化、门静脉高压引起的常见并发症,目前临床治疗脾亢的主要方式是脾切除和部分脾动脉栓塞(PSE)。脾切除治疗脾亢效果确切,可显著改善脾亢患者临床症状。相比于脾切除,部分脾动脉栓塞通过栓塞脾动脉分支使部分脾实质梗死,能够达到与部分脾切除术相似的临床疗效,并保留脾脏及脾脏自身功能。虽然PSE是治疗脾亢的有效方法,但是目前国内外关于PSE对肝纤维化、免疫及肝再生影响的研究报道并不多。本文总结了脾亢发生的常见病因、PSE治疗脾亢机制、不同栓塞方法和材料的治疗效果,以及PSE对肝纤维化、免疫及肝再生的影响,为临床脾亢治疗提供理论依据和新的思路。Abstract: Hypersplenism is a common complication caused by liver cirrhosis and portal hypertension, and at present, splenectomy and partial splenic artery embolization (PSE) are the main methods for the treatment of hypersplenism. Splenectomy has a marked effect in the treatment of hypersplenism and can significantly improve the clinical symptoms of patients with hypersplenism. Compared with splenectomy, PSE causes partial splenic parenchymal infarction and thus achieve similar clinical efficacy as partial splenectomy while preserving the spleen and its function. Although PSE is an effective method for the treatment of hypersplenism, there are few reports on the effect of PSE on liver fibrosis, immunity, and liver regeneration in China and globally. This article summarizes the common causes of hypersplenism, the mechanism of PSE in the treatment of hypersplenism, the therapeutic effect of different embolization methods and materials, and the effect of PSE on liver fibrosis, immunity, and liver regeneration, so as to provide a theoretical basis and new ideas for the clinical treatment of hypersplenism.
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Key words:
- Liver Cirrhosis /
- Hypertension, Portal /
- Hypersplenism
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[1] PASSHAK M, SHACHAR SS, OFER A, et al. Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients[J]. Support Care Cancer, 2018, 26(10): 3527-3532. DOI: 10.1007/s00520-018-4192-3. [2] HUANG Y, REN D, GAO F, et al. An updated meta-analysis of partial splenic embolization versus splenectomy in the treatment of hypersplenism due to cirrhosis[J]. Minim Invasive Ther Allied Technol, 2022, 31(5): 664-675. DOI: 10.1080/13645706.2021.1933535. [3] LEE YA, WALLACE MC, FRIEDMAN SL. Pathobiology of liver fibrosis: a translational success story[J]. Gut, 2015, 64(5): 830-841. DOI: 10.1136/gutjnl-2014-306842. [4] PAROLA M, PINZANI M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues[J]. Mol Aspects Med, 2019, 65: 37-55. DOI: 10.1016/j.mam.2018.09.002. [5] HUANG Q, YANG Y, ZENG R, et al. Regulation of liver fibrosis by matrix metalloproteinase/tissue inhibitor of metalloproteinase and research advances in related therapeutic drugs[J]. J Clin Hepatol, 2022, 38(6): 1420-1425. DOI: 10.3969/j.issn.1001-5256.2022.06.042.黄倩, 杨燕, 曾锐, 等. 基质金属蛋白酶/基质金属蛋白酶水解酶对肝纤维化的调控及相关治疗药物研究进展[J]. 临床肝胆病杂志, 2022, 38(6): 1420-1425. DOI: 10.3969/j.issn.1001-5256.2022.06.042. [6] ROEHLEN N, CROUCHET E, BAUMERT TF. Liver fibrosis: Mechanistic concepts and therapeutic perspectives[J]. Cells, 2020, 9(4): 875. DOI: 10.3390/cells9040875. [7] MITCHELL O, FELDMAN DM, DIAKOW M, et al. The pathophysiology of thrombocytopenia in chronic liver disease[J]. Hepat Med, 2016, 8: 39-50. DOI: 10.2147/HMER.S74612. [8] LU Y, LIN Y, HUANG X, et al. Oxaliplatin aggravates hepatic oxidative stress, inflammation and fibrosis in a non-alcoholic fatty liver disease mouse model[J]. Int J Mol Med, 2019, 43(6): 2398-2408. DOI: 10.3892/ijmm.2019.4154. [9] OZTURK O, ELDEM G, PEYNIRCIOGLU B, et al. Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension[J]. World J Gastroenterol, 2016, 22(43): 9623-9630. DOI: 10.3748/wjg.v22.i43.9623. [10] LI XQ, WANG YB, GONG JP, et al. Partial splenic embolization in treatment of hypersplenism secondary to liver cirrhosis: Meta-analysis[J]. Chin J Interv Imaging Ther, 2018, 15(3): 160-166. DOI: 10.13929/j.1672-8475.201704001.李学强, 王运兵, 龚建平, 等. 部分脾动脉栓塞治疗肝硬化继发脾功能亢进的Meta分析[J]. 中国介入影像与治疗学, 2018, 15(3): 160-166. DOI: 10.13929/j.1672-8475.201704001. [11] ISHIKAWA T, SASAKI R, NISHIMURA T, et al. Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism[J]. J Gastroenterol, 2021, 56(4): 382-394. DOI: 10.1007/s00535-021-01762-7. [12] CHEN Q, LI Z, YANG Y, et al. Partial splenic embolization through endoscopic ultrasound-guided implantation of coil as a potential technique to treat portal hypertension[J]. Endoscopy, 2021, 53(2): E40-E41. DOI: 10.1055/a-1174-5590. [13] ZAITOUN M, BASHA M, ELSAYED SB, et al. Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes[J]. Insights Imaging, 2021, 12(1): 85. DOI: 10.1186/s13244-021-01030-5. [14] HUANG JQ, WANG CX, ZHONG QS. Efficacy of splenic artery embolization with microspheres of different diameters in the treatment of hypersplenism[J]. J Proceeding Clin Med, 2022, 31(7): 501-504. DOI: 10.16047/j.cnki.cn14-1300/r.2022.07.016.黄敬泉, 王传香, 钟启盛. 不同直径微球脾动脉栓塞治疗脾功能亢进疗效观察[J]. 临床医药实践, 2022, 31(7): 501-504. DOI: 10.16047/j.cnki.cn14-1300/r.2022.07.016. [15] WEI XH, WANG J, ZU QQ, et al. Clinical comparative study of proximal and distal splenic artery embolization in the treatment of hypersplenism due to cirrhosis[J]. J Diagnostic Imaging Intervent Radiol, 2022, 31(4): 271-276. DOI: 10.3969/j.issn.1005-8001.2022.04.005.魏旭辉, 王杰, 祖庆泉, 等. 近端与远端脾动脉栓塞治疗肝硬化脾功能亢进的临床对比研究[J]. 影像诊断与介入放射学, 2022, 31(4): 271-276. DOI: 10.3969/j.issn.1005-8001.2022.04.005. [16] WANG T, ZHAO W, HU JH, et al. Therelated factors of severe complications occurring after partial splenic artery embolization for hypersplenism due to cirrhosis: a clinical analysis[J]. J Intervent Radiol, 2016, 25(7): 619-623. DOI: 10.3969/j.issn.1008-794X.2016.07.018.王彤, 赵卫, 胡继红, 等. 肝硬化脾功能亢进部分脾动脉栓塞术后严重并发症相关因素分析[J]. 介入放射学杂志, 2016, 25(7): 619-623. DOI: 10.3969/j.issn.1008-794X.2016.07.018. [17] KEMPINSKI R, NEUBAUER K, PONIEWIERKA E, et al. The immunoreactivity of TGF-b1 in non-alcoholic fatty liver disease[J]. Folia Histochem Cytobiol, 2019, 57(2): 74-83. DOI: 10.5603/FHC.a2019.0008. [18] CHEN Y, YUAN Y, LI W. Sorting machineries: how platelet-dense granules differ from α-granules[J]. Biosci Rep, 2018, 38(5): BSR20180458. DOI: 10.1042/BSR20180458. [19] GHAFOORY S, VARSHNEY R, ROBISON T, et al. Platelet TGF-β1 deficiency decreases liver fibrosis in a mouse model of liver injury[J]. Blood Adv, 2018, 2(5): 470-480. DOI: 10.1182/bloodadvances.2017010868. [20] REN CZ, HAO LS. Signal transduction involved in activation of hepatic stellate cells[J]. J Clin Hepatol, 2015, 31(3): 452-456. DOI: 10.3969/j.issn.1001-5256.2015.03.034.任昌镇, 郝礼森. 肝星状细胞活化过程中的信号转导[J]. 临床肝胆病杂志, 2015, 31(3): 452-456. DOI: 10.3969/j.issn.1001-5256.2015.03.034. [21] EZHILARASAN D. Endothelin-1 in portal hypertension: The intricate role of hepatic stellate cells[J]. Exp Biol Med (Maywood), 2020, 245(16): 1504-1512. DOI: 10.1177/1535370220949148. [22] TAKAHASHI K, MURATA S, FUKUNAGA K, et al. Human platelets inhibit liver fibrosis in severe combined immunodeficiency mice[J]. World J Gastroenterol, 2013, 19(32): 5250-5260. DOI: 10.3748/wjg.v19.i32.5250. [23] ZHANG XP, PAN WQ, ZHAO W, et al. The effect of partial splenic arterial embolization on liver function and cirrhosis[J]. J Intervent Radiol, 2021, 30(8): 823-827. DOI: 10.3969/j.issn.1008-794X.2021.08.016.张雪平, 潘文秋, 赵卫, 等. 部分脾动脉栓塞术对肝功能和肝硬化的影响[J]. 介入放射学杂志, 2021, 30(8): 823-827. DOI: 10.3969/j.issn.1008-794X.2021.08.016. [24] 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. DOI: 10.1186/s12967-017-1214-8. [25] TANABE K, TAURA K, KOYAMA Y, et al. Migration of splenic lymphocytes promotes liver fibrosis through modification of T helper cytokine balance in mice[J]. J Gastroenterol, 2015, 50(10): 1054-1068. DOI: 10.1007/s00535-015-1054-3. [26] MATSUKIYO Y, NAGAI H, MATSUI T, et al. Host immunological effects of partial splenic embolization in patients with liver cirrhosis[J]. J Immunol Res, 2018, 2018: 1746391. DOI: 10.1155/2018/1746391. [27] MELHEM A, MUHANNA N, BISHARA A, et al. Anti-fibrotic activity of NK cells in experimental liver injury through killing of activated HSC[J]. J Hepatol, 2006, 45(1): 60-71. DOI: 10.1016/j.jhep.2005.12.025. [28] ZHANG XP, PAN WQ, ZHAO W, et al. Effect of partial splenic embolization on the immune function in cirrhosis patients with hypersplenism[J]. J Intervent Radiol, 2021, 30(9): 929-931. DOI: 10.3969/j.issn.1008-794X.2021.09.015.张雪平, 潘文秋, 赵卫, 等. 部分脾动脉栓塞术对肝硬化脾功能亢进患者免疫功能的影响[J]. 介入放射学杂志, 2021, 30(9): 929-931. DOI: 10.3969/j.issn.1008-794X.2021.09.015. [29] HIRAKAWA Y, OGATA T, SASADA T, et al. Immunological consequences following splenectomy in patients with liver cirrhosis[J]. Exp Ther Med, 2019, 18(1): 848-856. DOI: 10.3892/etm.2019.7640. [30] EGGERT T, GRETEN TF. Tumor regulation of the tissue environment in the liver[J]. Pharmacol Ther, 2017, 173: 47-57. DOI: 10.1016/j.pharmthera.2017.02.005. [31] HUANG N, ZHOU R, CHEN H, et al. Splenic CD4+ and CD8+ T-cells highly expressed PD-1 and Tim-3 in cirrhotic patients with HCV infection and portal hypertension[J]. Int J Immunopathol Pharmacol, 2021, 35: 20587384211061051. DOI: 10.1177/20587384211061051. [32] GOLSAZ-SHIRAZI F, SHOKRI F. Hepatitis B immunopathogenesis and immunotherapy[J]. Immunotherapy, 2016, 8(4): 461-477. DOI: 10.2217/imt.16.3. [33] KUDO M. Immuno-oncology in hepatocellular carcinoma: 2017 Update[J]. Oncology, 2017, 93 Suppl 1: 147-159. DOI: 10.1159/000481245. [34] JIA Z, ZHANG K, HUANG RH, et al. The study of cellular immune function and its clinical significance in patients with liver cancer combined with liver cirrhosis and hypersplenism[J]. J Chin Hepatol, 2021, 26(6): 632-637. DOI: 10.14000/j.cnki.issn.1008-1704.2021.06.016.贾哲, 张珂, 黄容海, 等. 肝癌合并肝硬化脾功能亢进患者的细胞免疫功能研究及临床意义[J]. 肝脏, 2021, 26(6): 632-637. DOI: 10.14000/j.cnki.issn.1008-1704.2021.06.016. [35] LV X, YANG F, GUO X, et al. Erratum to: Hypersplenism is correlated with increased risk of hepatocellular carcinoma in patients with post-hepatitis cirrhosis[J]. Tumour Biol, 2016, 37(7): 9989. DOI: 10.1007/s13277-016-5056-4. [36] JIN GY, LV CZ, TANG D, et al. Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism[J]. Asian Pac J Trop Med, 2016, 9(7): 702-706. DOI: 10.1016/j.apjtm.2016.05.005. [37] WANG ZL, XU DF, LI C, et al. The research progress in relationship between immune function and Th1/Th2 cell in patients with hepatocellular carcinoma[J]. Med Recapitulate, 2013, 19(17): 3136-3139. DOI: 10.3969/j.issn.1006-2084.2013.17.021.王志利, 徐丹凤, 李闯, 等. 肝细胞癌患者免疫功能变化与Th1/Th2型细胞相关性的研究进展[J]. 医学综述, 2013, 19(17): 3136-3139. DOI: 10.3969/j.issn.1006-2084.2013.17.021. [38] ZHANG WY, CHA YF. The influence of TACE combined with partial splenic embolization on the immune function in patients with hepatocellular carcinoma[J]. J Clin Radiol, 2015, 34(3): 451-454. DOI: 10.13437/j.cnki.jcr.2015.03.036.章万勇, 查云飞. TACE联合部分脾栓塞术对肝癌患者免疫功能影响研究[J]. 临床放射学杂志, 2015, 34(3): 451-454. DOI: 10.13437/j.cnki.jcr.2015.03.036. [39] 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. DOI: 10.1111/hepr.12573. [40] MEYER J, BALAPHAS A, FONTANA P, et al. Platelet interactions with liver sinusoidal endothelial cells and hepatic stellate cells lead to hepatocyte proliferation[J]. Cells, 2020, 9(5): 1243. DOI: 10.3390/cells9051243. [41] TAKAHASHI K, LIANG C, ODA T, et al. Platelet and liver regeneration after liver surgery[J]. Surg Today, 2020, 50(9): 974-983. DOI: 10.1007/s00595-019-01890-x. [42] ISHIKAWA T, KUBOTA T, HORIGOME R, et al. Concurrent partial splenic embolization with transcatheter arterial chemoembolization for hepatocellular carcinoma can maintain hepatic functional reserve[J]. Hepatol Res, 2014, 44(11): 1056-1061. DOI: 10.1111/hepr.12222.
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