Activated intestinal macrophages in patients with cirrhosis release NO and IL-6 that may disrupt intestinal barrier function

摘要

Bacterial infections commonly complicate decom-pensated cirrhosis and are thought to be associated with increased bacterial translocation across the intestinal barrier (Gastroenterology 2011;141:1220-1230; Hepatology 2006;44:633-639). Alterations in circulating bacterial DNA, even in the presence of negative cultures, increases the risk of hepatic decompensation, variceal hemorrhage, and hep-atorenal syndrome (Gastroenterology 2007; 133: 818-824). In health, the gut epithelial barrier provides an effective barrier against microorganisms while simultaneously providing a semipermeable membrane for nutrient absorption (Nat Rev Immunol 2009;9:799-809). In cirrhosis, studies have confirmed that intestinal bacterial flora is altered (Hepatology 2006;45:744-757). However, it is unclear why the intestinal epithelial barrier fails, facilitating translocation of bacterial products and DNA (Hepatology 2008;48:1924-1931; Hepatology 2010;52:2044-2052).