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肝衰竭时胆汁淤积的发生机制及处置对策

毛青

引用本文:
Citation:

肝衰竭时胆汁淤积的发生机制及处置对策

DOI: 10.3969/j.issn.1001-5256.2019.02.004
详细信息
  • 中图分类号: R575.3

Pathogenesis and management strategies of liver failure-associated cholestasis

  • 摘要:

    肝衰竭是多种因素引起的严重肝脏损害。肝衰竭时胆汁淤积是一种以大量肝细胞坏死为主要原因的严重肝细胞性肝内胆汁淤积,表现为结合胆红素和非结合胆红素同时急剧增高,且其水平与肝衰竭严重程度呈正比。肝脏组织结构改变加重胆汁淤积,肠道微生物群对胆红素和胆汁酸代谢有影响。治疗肝衰竭时胆汁淤积的根本措施是去除病因,促进肝细胞再生和肝功能恢复。

     

  • [1]Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guideline for diagnosis and treatment of liver failure (2018) [J].J Clin Hepatol, 2019, 35 (1) :38-44. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2018年版) [J].临床肝胆病杂志, 2019, 35 (1) :38-44.
    [2]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and treatment of cholestasis liver diseases (2015) [J].J Clin Hepatol, 2015, 31 (12) :1989-1999. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.胆汁淤积性肝病诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2015, 31 (12) :1989-1999.
    [3]WATANABE M, FUKIYA S, YOKOTA A.Comprehensive evaluation of the bactericidal activitiesof free bile acids in the large intestine of humans and rodents[J].J Lipid Res, 2017, 58 (6) :1143-1152.
    [4]DEVKOTA S, CHANG EB.Interactions between diet, bile acid metabolism, gut microbiota, and inflammatory bowel diseases[J].Dig Dis, 2015, 33 (3) :351-356.
    [5]GAHAN CG, HILL C.Listeria monocytogenes:Survival and adaptation in the gastrointestinal tract[J].Front Cell Infect Microbiol, 2014, 4:9.
    [6]GERARD P.Metabolism of cholesterol and bile acids by the gut microbiota[J].Pathogens, 2013, 3 (1) :14-24.
    [7]JONES H, ALPINI G, FRANCIS H.Bile acid signaling and biliary functions[J].Acta Pharm Sin B, 2015, 5 (2) :123-128.
    [8]LI Y, TANG R, LEUNGG PSC, et al.Bile acids and intestinal microbiota in autoimmune cholestatic liver diseases[J].Autoimmun Rev, 2017, 16 (9) :885-896.
    [9]CHEN Y, YANG F, LU H, et al.Characterization of fecal microbial communities in patients with liver cirrhosis[J].Hepatology, 2011, 54 (2) :562-572.
    [10]TRAUNER M, FICKERT P, TILG H.Bile acids as modulators of gut microbiota linking dietary habits and inflammatory bowel disease:A potentially dangerous liaison[J].Gastroenterology, 2013, 144 (4) :844-846.
    [11]AVANCINI J, MARAGNO L, SANTI CG, et al.Drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome:Clinical features of 27 patients[J].Clin Exp Dermatol, 2015, 40 (8) :851-859.
    [12]MENDIZABAL M, MARCIANO S, VIDELA MG, et al.Fulminant presentation of autoimmune hepatitis:Clinical features and early predictors of corticosteroid treatment failure[J].Eur J Gastroenterol Hepatol, 2015, 27 (6) :644-648.
    [13]LOUVET A, THURSZ MR, KIM DJ, et al.Corticosteroids reduce risk of death within 28 days for patients with severe alcoholic hepatitis, compared with pentoxifylline or placebo-a meta-analysis of individual data from controlled trials[J].Gastroenterology, 2018, 155 (2) :458-468.
    [14]ZHANG XQ, JIANG L, MAO Q.Efficacy of short-term dexamethasone therapy in acute-on-chronic pre-liver failure[J].Hepatol Res, 2011, 41 (1) :46-53.
    [15]GREEN JL, HEARD KJ, REYNOLDS KM, et al.Oral and intravenous acetylcysteine for treatment of acetaminophen toxicity:A systematic review and meta-analysis[J].West J Emerg Med, 2013, 14 (3) :218-226.
    [16]HU J, ZHANG Q, REN X, et al.Efficacy and safety of acetylcysteine in"non-acetaminophen"acute liver failure:A meta-analysis of prospective clinical trials[J].Clin Res Hepatol Gastroenterol, 2015, 39 (5) :594-599.
    [17]SINGH S, HYNAN LS, LEE WM.Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage nonacetaminophen acute liver failure[J].Dig Dis Sci, 2013, 58 (5) :1397-1402.
    [18]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.
    [19]BANIASADI S, EFTEKHARI P, TABARSI P, et al.Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity[J].Eur J Gastroenterol Hepatol, 2010, 22 (10) :1235-1238.
    [20]KARVELLAS CJ, CAVAZOS J, BATTENHOUSE H, et al.Effects of antimicrobial prophylaxis and blood stream infections in patients with acute liver failure:A retrospective cohort study[J].Clin Gastroenterol Hepatol, 2014, 12 (11) :1942-1949.
    [21] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association.Guideline for non-bioartificial liver support systems in treatment of liver failure:2016 update[J].Chin J Clin Infect Dis, 2016, 9 (2) :97-103. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组.非生物型人工肝治疗肝衰竭指南 (2016年版) [J].中华临床感染病杂志, 2016, 9 (2) :97-103.
    [22]TILG H, CANI PD, MAYER EA.Gut microbiome and liver diseases[J].Gut, 2016, 65 (12) :2035-2044.
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  • 出版日期:  2019-02-20
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