肝损伤的常见致病因素和发病机理

1,2(),1,3()R575.2+9A1606-8106(2008)02-0128-03,,[131,,T(HBV),:(1);(2)[4]:HBV,,,HBsAgHBcAgHBeAg,,,,HBV,-HBs(IFN-):,,,,,,,HLA-1,HLA-1:(:30300153):1130021,4612,3,,;,(,),,MHC-1,,-168(interleukin-1,6,8,IL-1,6,8)(tumornecrosisfactora,TNF-)(leukotrienes,LTs),IL-1TNF-(ICAM-1/LFA-1LFA3/CD2),LTsIL-18TNF-IL-1,,,T,IL-2IL-2R,,T,T,,CD+8T(cytotoxicTlymphocyte,CTL)[5]CTL,,,,,Na+,K+,HLA-CD+4T(Th),CD+4Th,B,,,(antibody-dependentcell-mediatedcytotoxicity,ADCC),821ChineseJournalofTraditional&WesternMedicine200892M,,,TNF-,,;,(naturalkillercell,NK),NKICAM-1ICAM-1,22.1200,,P450,,:(1),,,,,DNA,,,(2)P450,,,(3),,CD+8T,B,,,ADCC(4)P450,,,(5),,,(GSH)ECP450,P450,,,Jiang[6]P4502E1(CYP2E1)10,P4502E13.7;21,P4502E14.61.7-10,P4502E113%18%,21,P4502E126%,P4502E1P4502E1-,P4502E1,2.2(CCl4)CCl4,P450CCl4,(CCl3+),,,CCl3+,,CCl3+,Ca2+,,CCl3+CCl4,Samar[7],Stephen[8]Takaya[9]2.3(1):,(ADH),10mmol/L,MEOSCYP2E1,,,CYP2E1ADCC,(2)921ChineseJournalofTraditional&WesternMedicine200892:,ADH(),,,(3):,,,,(4):,TNF-,,,(5):,,,,,5%,1/3,,;;,;,,3,P450CYP2E1,CYP2E1,,(ALD),CYP2E1,ADHMEOSALDH(),ADHCYP2E1ALDH,,,()1GarciaTsaoG,SanyalAJ,GraceND,etal.Preventionandmanagementofgastroesophagealvaricesandvaricealhemorrhageincirrhosis.Hepatology,2007,46(3):922-938.2RunyonBA.Apilladaycanimprovesurvivalinpatientswithadvancedcirrhosis.Gastroenterology,2007,133(3):1029-1031.3SalernoF,GerbesA,GinesP,etal.Diagnosis,preventionandtreatmentofhepatorenalsyndromeincirrhosis.Gut,2007,56(9):1310-1318.4,,..:,2002,27-30.5MainiMK,BoniC,LeeCK,etal.Theroleofvirus-specificCD+8cellinliverdamageandviralcontrolduringpersistenthepatitisBvirusinfection.JExpMed.2000,191:1269-1280.6JiangYUE,Ren-xiuPENG,JingYANG,etal.CYP2E1mediatedisoniazid-inducedhepatotoxicityinrats.ActaPharmacol.2004,25(5):699-704.7BasuS.Carbontetrachloride-inducedlipidperoxidation:eicosanoidformationandtheirregulationbyantioxidantnutrients.Toxicology.2003,189(1-2):113-127.8RobertsSM,HarbisonRD,WesthouseRA,etal.Exacerbationofcarbontetrachloride-inducedliverinjuryintheratbymethamphetamine.ToxicolLett.1995,76(1):77-83.9MurakamiT,NagamuraY,HiranoK,etal.EthanolaminestimulatesrepairprocessesinacuteCCl4damageofmouseliver.ToxicolLett,1998,94(2):137-144.(:)031ChineseJournalofTraditional&WesternMedicine200892