|
|
肝纤维化患者血液循环机制研究
|
Abstract:
慢性弥漫性肝病不仅出现肝炎、肝纤维化等一系列病理表现，还影响着肝脏血液循环，当肝纤维化形成时，肝脏血液循环障碍主要体现肝内外血管血流动力学变化，可一定程度反映疾病进展程度。本文主要对近年来对肝脏血液循环相关研究进行综述，进一步了解肝血流特征和肝内外血流动力学改变病理生理机制，以期对于肝脏病变诊断及临床诊治提供参考。
Chronic diffuse liver disease not only presents a series of pathological manifestations such as hepa-titis and hepatic fibrosis, but also affects hepatic blood circulation. Hepatic blood circulation disor-der mainly reflects the hemodynamic changes of blood vessels inside and outside the liver, which can reflect the degree of disease progression to a certain extent. This article mainly reviews the re-search on liver blood circulation in recent years to further understand the characteristics of liver blood flow and the pathophysiological mechanism of changes in intrahepatic and extrahepatic he-modynamics, so as to provide reference for the diagnosis and clinical diagnosis of liver diseases.
| [1] | Kim, M.Y., Baik, S.K. and Lee, S.S. (2010) Hemodynamic Alterations in Cirrhosis and Portal Hypertension. The Korean Journal of Hepatology, 16, 347-352. https://doi.org/10.3350/kjhep.2010.16.4.347 |
| [2] | Berumen, J., Baglieri, J., Kisseleva, T. and Mekeel, K. (2021) Liver Fibrosis: Pathophysiology and Clinical Implications. WIREs Mechanisms of Disease, 13, e1499. https://doi.org/10.1002/wsbm.1499 |
| [3] | M？ller, S. and Bendtsen, F. (2018) The Pathophysi-ology of Arterial Vasodilatation and Hyperdynamic Circulation in Cirrhosis. Liver International, 38, 570-580. https://doi.org/10.1111/liv.13589 |
| [4] | 王宇, 王民, 张冠华, 何福亮, 欧晓娟, 王晓明, 贾继东. 循环系统疾病的肝脏表现[J]. 中华肝脏病杂志, 2022, 30(4): 362-366. https://doi.org/10.3760/cma.j.cn501113-20220318-00121 |
| [5] | Kobayashi, S. (2021) Hepatic Pseudolesions Caused by Alterations in Intrahepatic Hemodynamics. World Journal of Gastroenterology, 27, 7894-7908. https://doi.org/10.3748/wjg.v27.i46.7894 |
| [6] | Wang, Q., Koniaris, L.G., Milgrom, D.P., Patel, A., Hu, M., Cui, E., Deng, Y. and Akisik, F. (2019) CT and MRI Imaging and Interpretation of Hepatic Arterioportal Shunts. Translational Gastroenterology and Hepatology, 4, Article No. 34. https://doi.org/10.21037/tgh.2019.05.05 |
| [7] | Zhang, L., Yin, J., Duan, Y., Yang, Y., Yuan, L. and Cao, T. (2011) Assessment of Intrahepatic Blood Flow by Doppler Ultrasonogra-phy: Relationship between the Hepatic Vein, Portal Vein, Hepatic Artery and Portal Pressure Measured Intraoperatively in Patients with Portal Hypertension. BMC Gastroenterology, 11, Article No. 84.
https://doi.org/10.1186/1471-230X-11-84 |
| [8] | Jha, R.C., Khera, S.S. and Kalaria, A.D. (2018) Portal Vein Thrombosis: Imaging the Spectrum of Disease with an Emphasis on MRI Features. AJR. American Journal of Roentgen-ology, 211, 14-24.
https://doi.org/10.2214/AJR.18.19548 |
| [9] | Ozaki, K., Kozaka, K., Kosaka, Y., Kimura, H. and Gabata, T. (2020) Morphometric Changes and Imaging Findings of Diffuse Liver Disease in Relation to Intrahepatic Hemodynamics. Jap-anese Journal of Radiology, 38, 833-852.
https://doi.org/10.1007/s11604-020-00978-6 |
| [10] | Maeso-Díaz, R., Ortega-Ribera, M., Fernández-Iglesias, A., Hide, D., Mu？oz, L., Hessheimer, A.J., Vila, S., Francés, R., Fondevila, C., Albillos, A., Peralta, C., Bosch, J., Tacke, F., Cogger, V.C. and Gracia-Sancho, J. (2018) Effects of Aging on Liver Microcirculatory Function and Sinusoidal Pheno-type. Aging Cell, 17, e12829.
https://doi.org/10.1111/acel.12829 |
| [11] | Davies, T., Wythe, S., O’Beirne, J., Martin, D. and Gilbert-Kawai, E. (2017) Review Article: The Role of the Microcirculation in Liver Cirrhosis. Alimentary Pharmacology & Therapeutics, 46, 825-835.
https://doi.org/10.1111/apt.14279 |
| [12] | Ayd？n, M.M. and Ak？al？, K.C. (2018) Liver Fibrosis. Turkish Journal of Gastroenterology, 29, 14-21.
https://doi.org/10.5152/tjg.2018.17330 |
| [13] | Roehlen, N., Crouchet, E. and Baumert, T.F. (2020) Liver Fibrosis: Mechanistic Concepts and Therapeutic Perspectives. Cells, 9, 875-888. https://doi.org/10.3390/cells9040875 |
| [14] | Dhar, D., Baglieri, J., Kisseleva, T. and Brenner, D.A. (2020) Mecha-nisms of Liver Fibrosis and Its Role in Liver Cancer. Experimental Biology and Medicine (Maywood), 245, 96-108. https://doi.org/10.1177/1535370219898141 |
| [15] | Garbuzenko, D.V. (2022) Pathophysiological Mechanisms of Hepatic Stellate Cells Activation in Liver Fibrosis. World Journal of Clinical Cases, 10, 3662-3676. https://doi.org/10.12998/wjcc.v10.i12.3662 |
| [16] | Friedman, S.L. and Pinzani, M. (2022) Hepatic Fibrosis 2022: Unmet Needs and a Blueprint for the Future. Hepatology, 75, 473-488. https://doi.org/10.1002/hep.32285 |
| [17] | Foglia, B., Cannito, S., Bocca, C., Parola, M. and Novo, E. (2019) ERK Pathway in Activated, Myofibroblast-Like, Hepatic Stellate Cells: A Critical Signaling Crossroad Sustaining Liver Fibro-sis. International Journal of Molecular Sciences, 20, Article No. 2700. https://doi.org/10.3390/ijms20112700 |
| [18] | Yang, F., Li, H., Li, Y., Hao, Y., Wang, C., Jia, P., Chen, X., Ma, S. and Xiao, Z. (2021) Crosstalk between Hepatic Stellate Cells and Surrounding Cells in Hepatic Fibrosis. International Immunopharmacology, 99, Article ID: 108051.
https://doi.org/10.1016/j.intimp.2021.108051 |
| [19] | Iwakiri, Y. (2007) The Molecules: Mechanisms of Arterial Vasodilatation Observed in the Splanchnic and Systemic Circulation in Portal Hypertension. Journal of Clinical Gastro-enterology, 41, S288-S294.
https://doi.org/10.1097/MCG.0b013e3181468b4c |
| [20] | Bosch, J., Groszmann, R.J. and Shah, V.H. (2015) Evolu-tion in the Understanding of the Pathophysiological Basis of Portal Hypertension: How Changes in Paradigm Are Lead-ing to Successful New Treatments. Journal of Hepatology, 62, S121-S130. https://doi.org/10.1016/j.jhep.2015.01.003 |
| [21] | Iwakiri, Y. (2012) Endothelial Dysfunction in the Regulation of Cirrhosis and Portal Hypertension. Liver International, 32, 199-213. https://doi.org/10.1111/j.1478-3231.2011.02579.x |
| [22] | Luo, N., Li, J., Wei, Y., Lu, J. and Dong, R. (2021) Hepat-ic Stellate Cell: A Double-Edged Sword in the Liver. Physiological Research, 70, 821-829. https://doi.org/10.33549/physiolres.934755 |
| [23] | Zou, G.L., Zuo, S., Lu, S., Hu, R.H., Lu, Y.Y., Yang, J., Deng, K.S., Wu, Y.T., Mu, M., Zhu, J.J., Zeng, J., Zhang, B.F., Wu, X., Zhao, X.K. and Li, H.Y. (2019) Bone Morphogenetic Protein-7 Represses Hepatic Stellate Cell Activation and Liver Fibrosis via Regulation of TGF-β/Smad Signaling Path-way. World Journal of Gastroenterology, 25, 4222-4234.
https://doi.org/10.3748/wjg.v25.i30.4222 |
| [24] | Shenoda, B. and Boselli, J. (2019) Vascular Syndromes in Liver Cirrhosis. Clinical Journal of Gastroenterology, 12, 387-397. https://doi.org/10.1007/s12328-019-00956-0 |
| [25] | 徐德强, 杨俊. 肝硬化门静脉血栓形成的相关性研究[J]. 中华肝脏病杂志, 2020, 28(7): 573-579.
https://doi.org/10.3760/cma.j.cn501113-20190404-00107 |
| [26] | 蒋煊, 夏炳兰, 柏斗胜. 超声评估乙型肝炎肝硬化患者抗病毒干预后肝脏血流动力学变化的临床价值[J]. 现代消化及介入诊疗, 2018, 23(5): 596-599. https://doi.org/10.3969/j.Issn.1672-2159.2018.05.016 |
| [27] | Bolognesi, M., Di Pascoli, M., Verardo, A. and Gatta, A. (2014) Splanchnic Vasodilation and Hyperdynamic Circulatory Syndrome in Cirrhosis. World Journal of Gastroen-terology, 20, 2555-2563.
https://doi.org/10.3748/wjg.v20.i10.2555 |
| [28] | McAvoy, N.C., Semple, S., Richards, J.M., Robson, A.J., Patel, D., Jardine, A.G., Leyland, K., Cooper, A.S., Newby, D.E. and Hayes, P.C. (2016) Differential Visceral Blood Flow in the Hyperdynamic Circulation of Patients with Liver Cirrhosis. Alimentary Pharmacology & Therapeutics, 43, 947-954. https://doi.org/10.1111/apt.13571 |
| [29] | Csak, T. and Bernstein, D. (2022) Hepatorenal Syndrome: Pathophysiology. Clinical Liver Disease, 26, 165-179.
https://doi.org/10.1016/j.cld.2022.01.013 |
| [30] | McConnell, M. and Iwakiri, Y. (2018) Biology of Portal Hyperten-sion. Hepatology International, 12, 11-23.
https://doi.org/10.1007/s12072-017-9826-x |
| [31] | Payancé, A. and Rautou, P.E. (2018) Cirrhosis Regression: Ex-trahepatic Angiogenesis and Liver Hyperarterialization Persist. Clinical Science (London), 132, 1341-1343. https://doi.org/10.1042/CS20180129 |
