New clinical and pathophysiological perspectives defining the trajectory of cirrhosis

JOURNAL OF HEPATOLOGY

卷:75

Review

Jalan, Rajiv^1,2  D'Amico, Gennaro^3,4  Trebicka, Jonel⁵  Moreau, Richard^1,6,7  Angeli, Paolo^1,8  Arroyo, Vicente¹ 

[1] EF Clif, European Fdn Study Chron Liver Failure, Barcelona, Spain

[2] Royal Free Hosp, Liver Failure Grp, Inst Liver & Digest Hlth, UCL Med Sch, Rowland Hill St, London NW3 2PF, England

[3] Osped Cervello, Gastroenterol Unit, Palermo, Italy

[4] Univ Palermo, Palermo, Italy

[5] JW Goethe Univ Hosp, Frankfurt, Germany

[6] Hop Beaujon, AP HP, Serv Hepatol, Clichy, France

[7] Univ Paris, Ctr Rech Sur Inflammat, INSERM, Paris, France

[8] Univ Padua, Padua, Italy

关键词: Cirrhosis;    Acute on chronic liver failure;    Inflammation;    Varices;    Ascites;    Hepatic encephalopathy;    Infection;   

DOI  :  10.1016/j.jhep.2021.01.018

来源: Elsevier

【 摘 要 】

Traditionally, the complications of cirrhosis, namely variceal bleeding, ascites and hepatic encephalopathy, were thought to result predominantly from circulatory dysfunction and altered organ perfusion arising as a result of portal hypertension. Over the past 20 years, large, international prospective studies have indicated the importance of systemic inflammation and organ immunopathology as additional determinants of organ dysfunction in cirrhosis, which not only manifests in the liver, brain, circulation and the kidneys, but also the immune system, gut, muscles, adrenal glands, reproductive organs, heart and lungs. This review provides an overview of the traditional and emerging concepts around the initiation and maintenance of organ dysfunction in cirrhosis and proposes a new paradigm based upon a better understanding of acute decompensation of cirrhosis. The interaction between the traditional concepts and the emerging perspectives remains a matter of great interest and the basis for future research. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free