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Pathogenese und Progression der Leberzirrhose: aktuelle Perspektiven

Pathogenesis and progression of liver cirrhosis: current perspectives

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Zusammenfassung

Die Leberzirrhose wurde traditionell lange als irreversibles Endstadium verschiedener chronischer Lebererkrankungen betrachtet, das über die Entwicklung portalhypertensiver Komplikationen und Leberinsuffizienz zum Tod führt. Heute versteht man die Leberzirrhose als ein heterogenes, prinzipiell reversibles Krankheitsbild, bei dem die Leber selbst in fortgeschrittenen Stadien einem ständigen Umbau infolge Fibrogenese und Fibroseregeneration unterliegt, portale Hypertension das Resultat intrahepatischer Vasokonstriktion und splanchnischer Vasodilatation darstellt und pathologische bakterielle Translokation klinische Dekompensation und Organversagen fördert. Während die Progression im kompensierten Stadium der Leberzirrhose vor allem durch eine Zunahme des portalen Drucks charakterisiert ist, geht sie im dekompensierten Stadium vor allem mit systemischer Inflammation einher. Ein zunehmendes Verständnis der stadienabhängig vorherrschenden Pathomechanismen bildet die Voraussetzung für individualisierte Therapieziele und personalisierte Therapieansätze.

Abstract

Cirrhosis has traditionally been regarded as an irreversible end-stage of various chronic liver diseases, leading to death via the development of portal hypertensive complications and hepatic insufficiency. Today, we understand cirrhosis as a heterogeneous and reversible clinical entity, in which the liver undergoes continuous remodeling even in advanced stages, in which portal hypertension is the result of intrahepatic vasoconstriction and splanchnic vasodilation, and in which pathological bacterial translocation contributes to clinical decompensation and organ failure. Whereas progression in compensated liver disease is characterized by an increase in portal pressure, systemic inflammation is a hallmark of decompensated disease. A better understanding of the stage-dependent predominant pathomechanisms is a prerequisite for individualized therapy targets and personalized therapeutic approaches.

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  1. Medizinische Klinik III, Universitätsklinikum Aachen, Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    T. Bruns & C. Trautwein

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T. Bruns und C. Trautwein geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C. Trautwein, Aachen

J. Trebicka, Frankfurt am Main

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Bruns, T., Trautwein, C. Pathogenese und Progression der Leberzirrhose: aktuelle Perspektiven. Gastroenterologe 16, 137–148 (2021). https://doi.org/10.1007/s11377-021-00517-3

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