Intestinal endotoxemia as a pathogenetic mechanism in liver failure

• Published in: World journal of gastroenterology : WJG Vol. 8; no. 6; pp. 961 - 965
• Main Author: Han, De-Wu
• Format: Journal Article
• Language: English
• Published: United States Institute of Hepatology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China 01.12.2002; Baishideng Publishing Group Inc
• Subjects: Animals; Endotoxemia - complications; Hepatitis - etiology; Humans; Intestinal Diseases - complications; Kupffer Cells - physiology; Liver - injuries; Liver Failure - etiology; LPS; Models, Biological; Phagocytosis; Topic Comment; 发病机制; 小肠内毒素血症; 肝损伤
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v8.i6.961

Liver injury induced by various pathogenic factors(such as hepatitis virus,ethanol,drugs and hepatotoxicants,etc.)through their respective special pathogenesis is referred to as“primary liver injury”(LPS)and the activation of kupffer cells by LPS while intestinal endotoxemia(IETM)occurted during the occurrence and development of hepatitis is named the“secondary liver injury”(SLI).The latter which has lost their own specificities of primary pathogenic factors is ascribed to IETM.The“secondary liver injury”is of important action and impact on development and prognosis of hepatitis.More severe IETM commonly results in excessive inflammatory responses,with serious hepatic necrosis,further severe hepatitis and even induces acute liver failure.The milder IETM successively precipitates a cascade,including repeated and persistent hepatocytic impairment accompanied by infiltration of inflammatory cells,hepatic fibrosis,cirrhosis and hepatocarcinoma.Generally,the milder IETM ends with chronic hepatic failure.If PLI caused by various pathogenic factors through their independent specific mechanismis regarded as“the first hit”on liver,then SLI mediated by different chemical mediators from KC,activated by IETMin the course of hepatitis is “the second hit”on liver.Thus,fusing and overlapping of the primary and scorndary liver injunies determine and influeuce the complexity of the illness and outcome of the patient with hepatitis.For this reason,the viewpoint of “SLI”induced by the “second hit”on liver inflicted by IETM suggests that medical professionals should attach great importance to both“PLI”and“SLI”caused by IETM.That is,try to adjust the function of KS,and eliminate endotoxemia ofthe patient.