慢性肝衰竭急性发作患者表现出“脓毒症样”免疫麻痹

作     者：Wasmuth H.E. Kunz D. Yagmur E. F. Lammert 王铮 

作者机构：Department of Medicine III University Hospital Aachen (UKA) Aachen University (RWTH) Pauwelss trasse 30 D-52074 Aachen Germany 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第6期

页      面：55-55页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：慢性肝衰竭 脓毒症 免疫麻痹 急性发作 肝纤维化患者 功能性免疫 全血标本 免疫功能障碍 免疫抑制 感染性疾病 

摘      要：Cellular immune depression is linked to high mortality in sepsis, but has yet to be systematically analysed in liver cirrhosis. The aim of the present study was to directly compare functional immune parameters in patients with acute on chronic liver failure (ACLF), severe sepsis, and non-decompensated cirrhosis. Patients with ACLF (n=27) were investigated at admission to a medical ICU. Patients with stable liver cirrhosis (n=24) and severe sepsis (n=31) served as control groups. In all subjects, serum levels of IL-6 and IL-10, ex vivo production of TNF-αin a whole blood assay, and monocyte surface HLA-DR expression were determined. In patients with ACLF or sepsis, ex vivo TNF-αproduction and HLA-DR expression were severely decreased compared to subjects with stable cirrhosis (both P 0.001). Contrary, IL-6 levels were highest in septic patients, followed by subjects with ACLF and cirrhotic patients (both P 0.05). Immune dysfunction in ACLF was independent of aetiology of liver cirrhosis and associated with high mortality. Patients with ACLF and severe sepsis show a similar degree of cellular immune depression. The reduced cellular immune function in subjects with ACLF might contribute to the increased infectious morbidity of these patients and provide a rational basis for prevention strategies.