Bacterial DNA Translocation Is Associated With Systemic Circulatory Abnormalities and Intrahepatic Endothelial Dysfunction in Patients With Cirrhosis
Bacterial DNA Translocation Is Associated With Systemic Circulatory Abnormalities and Intrahepatic Endothelial Dysfunction in Patients With Cirrhosis
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DOI：
10.1002/hep.23918
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发表时间：
2010-12-01
期刊：
影响因子：
13.5
通讯作者：
Bosch, Jaime
中科院分区：
文献类型：
--
作者：
Bellot, Pablo;Carlos Garcia-Pagan, Juan;Bosch, Jaime
在非感染的肝硬变和腹水患者中，细菌DNA的存在与显著的炎症反应有关，包括诱导型一氧化氮合酶的激活和一氧化氮的释放，与自发性细菌性腹膜炎患者的观察结果相似，尽管细菌DNA的存在与预后受损有关，对75例非感染的肝硬变患者(55例有腹水)进行了液体试餐前后的全身和肝脏血流动力学评估细菌DNA的检测仅在腹水患者中检测细菌DNA在有细菌DNA的腹水患者(n=21)和无细菌DNA的腹水患者(n=34)的临床资料和肝功能相似细菌DNA阳性患者的平均动脉压(P=0.002)和全身血管阻力(P=0.03)显著低于细菌DNA阴性患者的心输出量、心肺压、肝静脉压梯度(HVPG)、在试验餐后30min，两组患者的肝血流量和肝血流量无明显差异，在餐后充血引起的血流量增加时，细菌DNA阳性组的HVPG升高和肝血管重排受损的程度明显高于细菌DNA阳性组，提示肝内皮细胞功能障碍。确实，试验餐后HVPG的升高与血清细菌DNA浓度显著相关。结论细菌DNA是细菌易位的标志，细菌DNA的存在与外周血管扩张和肝内皮细胞功能障碍的加重有关(肝病学2010，52,2044-2052)
Presence of bacterial DNA in noninfected patients with cirrhosis and ascites is associated with a marked inflammatory response including activation of the inducible form of nitric oxide synthase and release of nitric oxide, similar to that observed in patients with spontaneous bacterial peritonitis Although presence of bacterial DNA is associated with an impaired prognosis, no information is available regarding its hemodynamic consequences Systemic and hepatic hemodynamics before and after a liquid test meal were assessed in a series of 75 noninfected patients with cirrhosis (55 with ascites) Bacterial DNA was measured by polymerase chain reaction Bacterial DNA was detected only in patients with ascites Clinical data and liver function were similar in ascitic patients with presence (n = 21) or absence of bacterial DNA (n = 34) Bacterial-DNA(+) patients had significantly lower mean arterial pressure (P = 0 002) and systemic vascular resistance (P = 0 03) than bacterial-DNA(-) patients Cardiac output, cardiopulmonary pressures, hepatic venous pressure gradient (HVPG), and hepatic blood flow were similar in both groups Thirty minutes after the test meal, in response to increased blood flow caused by postprandial hyperemia, there was a significantly greater increase in HVPG and impaired hepatic vasorelocation in bacterial-DNA(+) as compared with bacterial-DNA(-) patients, which indicates hepatic endothelial dysfunction Indeed, the increase in HVPG after the test meal significantly correlated with serum bacterial DNA concentration Conclusion Presence of bacterial DNA, a marker of bacterial translocation, is associated with aggravation of peripheral vasodilation and with worsening of intrahepatic endothelial dysfunction (HEPATOLOGY 2010,52 2044-2052)