Аннотация
Особенности микроциркуляции органов определяют характер их ишемического/реперфузионного
повреждения. В обзоре описан патогенез повреждения печеночных долек при нарушении микроциркуляции печени различного генеза. Описаны клинические проявления ишемического гепатита, диагностические критерии, определены максимально эффективные способы профилактики.
Особое внимание уделено развитию ишемического гепатита у кардиохирургических пациентов.
Литература
1. Laut W.W. Hepatic vasculature: a conceptual review.
Gastroenterology. 1981; 81: 159–73.
2. Mallory F.B. Necroses of the liver. J. Med. Res.
1901; 6 (1): 264–80.
3. Birgens H.S., Henriksen J., Matzen P., Poulsen H.
The shock liver. Acta Med. Scand. 1978; 204:
417–21.
4. Bynum T.E., Boitnott J.K., Maddrey W.C.
Ischemic hepatitis. Dig. Dis. Sci. 1979; 24: 129–35.
5. Chávez-Tapia N.C., Balderas-Garces B.V., Meza-
Meneses P., Herrera-Gomar M., García-López S.,
Gónzalez-Chon O., Uribe M. Hypoxic hepatitis in
cardiac intensive care unit: a study of cardiovascular
risk factors, clinical course, and outcomes. Ther.
Clin. Risk Manag. 2014; 10: 139–45.
6. Drolz A., Saxa R., Scherzer T., Fuhrmann V.
Extracorporeal artificial liver support in hypoxic
liver injury. Liver Int. 2011; 31 (Suppl. 3): 19–23.
7. Henrion J., Descamps O., Luwaert R. et al. Hypoxic
hepatitis in patients with cardiac failure: incidence
in a coronary care unit and measurement of
hepatic blood flow. J. Hepatol. 1994; 21: 696–703.
8. Raurich J.M., Llompart-Pou J.A., Ferreruela M.
et al. Hypoxic hepatitis in critically ill patients: incidence,
etiology and risk factors for mortality.
J. Anesth. 2011; 25: 50–6.
9. Laut W.W. Mechanism and role of intrinsic regulation
of hepatic arterial blood flow: hepatic arterial
buffer response. Am. J. Physiol. 1985; 249:
G549–56.
10. Spapen H. Liver perfusion in sepsis, septic shock
and multiorgan failure. Anat. Rec. 2008; 29:
714–20.
11. Fuhrmann V., Kneidinger N., Herkner H.,
Heinz G., Nikfardjam M., Bojic A. et al. Hypoxic
hepatitis: underlying conditions and risk factors for
mortality in critically ill patients. Intensive Care
Med. 2009; 35 (8): 1397–405.
12. Henrion J. Hypoxic hepatitis. Liver Int. 2012;
32 (7): 1039–52.
13. Birrer R., Takudan Y., Takara T. Hypoxic hepatopathy:
pathophysiology and prognosis. Intern. Med.
2007; 46: 1063–70.
14. Henrion J., Schapira M., Luwaert R. et al. Hypoxic
hepatitis. Clinical and hemodynamic study in 142
consecutive cases. Medicine. 2003; 82: 392–406.
15. Cohen J.A., Kaplan M.M. Left-sided heart failure
presenting as hepatitis. Gastroenterology. 1978;
74 (3): 583–7.
16. Kavoliuniene A., Vaitiekiene A., Cesnaite G.
Congestive hepatopathy and hypoxic hepatitis in
heart failure: a cardiologist's point of view. Int.
J. Cardiol. 2013; 166 (3): 554–8.
17. Giallourakis C.C., Rosenberg P.M., Friedman L.S.
The liver in heart failure. Clin. Liver Dis. 2002; 6 (4):
947–67, viii-ix. Rev.
18. Seeto R.K., Fenn B., Rockey D.C. Ischemic hepatitis:
clinical presentation and pathogenesis. Am. J.
Med. 2000; 109: 109–13.
19. Тe Boekhorst T., Urlus M., Doesburg W., Yap S.H.,
Goris R.J. Etiologic factors of jaundice in severely
ill patients. A retrospective study in patients admitted
to an intensive care unit with severe trauma or
with septic intra-abdominal complications following
surgery and without evidence of bile duct
obstruction. J. Hepatol. 1988; 7 (1): 111–7.
20. Edwards J.D. Oxygen transport in cardiogenic and
septic shock. Crit. Care Med. 1991; 19: 658–63.
21. De La Monte S.M., Arcidi J.M., Moore G.W.,
Hutchins G.M. Midzonal necrosis as a pattern of
hepatocellular injury after shock. Gastroenterology.
1984; 86: 627–31.
22. Miura F., Asano T., Amano H. Eleven cases of postoperative
hepatic infarction following pancreatobiliary
surgery. J. Gastrointest. Surg. 2010; 14: 352–8.
23. Zilkens C., Friese J., Köller M., Muhr G., Schinkel
C. Hepatic failure after injury – a common
pathogenesis with sclerosing cholangitis. Eur. J.
Med. Res. 2008; 13: 309–13.
24. Bansol V., Schuchert V.D. Jaundice in the intensive
care unit. Surg. Clin. N. Am. 2006; 86: 1495–502.
25. Strassburg C.P. Gastrointestinal disorders of the
critically ill. Shock liver. Best Pract. Res. Clin.
Gastroenterol. 2003; 17 (3): 369–81. Rev.
26. Brienza N., Dalfino L., Cinnella G., Diele C.,
Bruno F., Fiore T. Jaundice in critical illness: promoting
factors of a concealed reality. Intensive Care
Med. 2006; 32 (2): 267–74.
27. LaRusso N.F. Morphology, physiology, and biochemistry
of biliary epithelia. Toxicol. Pathol. 1996;
24: 84–9.
28. Rao R.K., Samak G. Bile duct epithelial tight junctions
and barrier function. Tissue Barriers. 2013;
1 (4): e25718.
29. Katz S., Jimenez M.A., Lehmkuhler W.E., Grosfeld
J.L. Liver bacterial clearance following hepatic
artery ligation and portacaval shunt. J. Surg. Res.
1991; 51: 267–70.
30. Shibuya H., Ohkohchi N., Seya K. et al. Kupffer
cells generate superoxide anions and modulate
reperfusion injury in rat livers after cold preservation.
Hepatology. 1997; 25: 356–60.
31. Jaeschke H., Woolbright B.L. Current strategies to
minimize hepatic ischemia-reperfusion injury by
targeting reactive oxygen species. Transplant. Rev.
(Orlando). 2012; 26 (2): 103–14.
32. Peralta C., Jiménez-Castro M.B., Gracia-Sancho J.
Hepatic ischemia and reperfusion injury: effects on
the liver sinusoidal milieu. J. Hepatol. 2013; 59 (5):
1094–106.
33. Henrion J., Deltenre P., De Maeght S., Peny M.O.,
Schapira M. Acute lower limb ischemia as a triggering
condition in hypoxic hepatitis: a study of
five cases. J. Clin. Gastroenterol. 2011; 45 (3):
274–7.
34. Bernal W., Wendon J. Acute liver failure. N. Engl. J.
Med. 2013; 369: 2525–34.
35. Раевнева Т.Г. Гипоксический гепатит. Медицинс-
кий журнал. 2014; 3: 131–4 / Raevneva T.G. Hypoxic
hepatitis. Meditsinskiy zhurnal. 2014; 3: 131–4
(in Russ.).
36. Fuhrmann V., Jäger B., Zubkova A., Drolz A.
Hypoxic hepatitis – epidemiology, pathophysiology
and clinical management. Wien Klin. Wochenschr.
2010; 122 (5–6): 129–39.
37. Ebert E.C. Hypoxic liver injury. Mayo Clin. Proc.
2006; 81 (9): 1232–6. Rev.
38. Henrion J. Ischemia/reperfusion injury of the liver:
pathophysiologic hypotheses and potential relevance
to human hypoxic hepatitis. Acta Gastroenterol.
Belg. 2000; 63 (4): 336–47. Rev.
39. Hawker F. Liver dysfunction in critical illness.
Anaesth. Intensive Care. 1991; 19 (2): 165–81. Rev.
40. Matsuda H., Covino E., Hirose H. et al. Acute liver
dysfunction after modified Fontan operation for
complex cardiac lesions. J. Thorac. Cardiovasc.
Surg. 1988; 96: 219–26.
41. Jenkins J.G., Lynn A.M., Wood A.E., Trusler G.A.,
Barker G.A. Acute hepatic failure following cardiac
operation in children. J. Thorac. Cardiovasc. Surg.
1982; 84: 865–71.
42. Michalopoulos A., Alivizatos P., Geroulanos S.
Hepatic dysfunction following cardiac surgery:
determinants and consequences. Hepatogastroenterology.
1997; 44 (15): 779–83.
43. Chu C.M., Chang C.H., Liaw Y.F., Hsieh M.J.
Jaundice after open heart surgery: a prospective
study. Thorax. 1984; 39 (1): 52–6.
44. Henrion J. Hypoxic hepatitis: the point of view of
the clinician. Acta Gastroenterol. Belg. 2007; 70 (2):
214–6. Rev.
Об авторах
Рыбка Михаил Михайлович, канд. мед. наук, зав. отделением; e-mail: rybkamikh@mail.ru
