Funktion des Immunsystems bei Leberzirrhose

Zusammenfassung

Bei Patienten mit Leberzirrhose lässt sich eine Reihe unterschiedlicher Fehlfunktionen im Immunsystem nachweisen. Diese betreffen sowohl die unspezifische Abwehr als auch die antigenspezifischen Reaktionen. Sehr gut untersucht und in seiner klinischen Bedeutung gut belegt ist die eingeschränkte Leistung des retikuloendothelialen Systems bei Leberzirrhose. Hier zeigt sich ein enger Zusammenhang zur Inzidenz bakterieller Infektionen und zur Prognose der Patienten. Andere Störungen wie die eingeschränkte Funktion neutrophiler Granulozyten sind wahrscheinlich für den klinischen Verlauf eher sekundär. Ob die gestörte Aktivierung der Natural-Killerzellen (NK-Zellen) und der lymphokinaktivierten Killerzellen (LAK-Zellen) eine Prädisposition für die Entwicklung eines hepatozellulären Karzinoms bei Leberzirrhose darstellt, müssen weitere Studien zeigen. Auffällig ist ein mäßig vermindertes Ansprechen auf Impfungen bei Leberzirrhose, was bei den meisten Impfstoffen aber durch eine Dosiserhöhung ausgeglichen werden kann.

Function of the immune system in liver cirrhosis

Malfunction of the immune system at different levels is typical for patients with liver cirrhosis. Both non-specific as well as antigen-specific functions may be compromised. The best studied and clinically most important problem is the diminished clearance capacity of the reticulo-endothelial system in liver cirrhosis. This transfers into a significantly higher rate of bacterial infections associated with a poorer prognosis in these patients. The clinical relevance of concomitant immune disorders like neutrophil dysfunction is less clear. An impaired activation of natural killer cells (NK) and lymphokine-actvated killer cells (LAK) may have a role in the development of hepatocellular carcinoma but additional studies are needed. Clinically important is a moderately reduced efficacy of standard immunization protocols, which can be overcome by an increased dose in most vaccines.

Schlüsselwörter

Immunsystem - Leberzirrhose - Infektionen - Makrophagen - RES - neutrophile Granulozyten - Natural-Killerzellen - Lymphozyten - Opsonine - Impfungen

Key words

Immune System - Liver Cirrhosis - Infections - Macrophages - RES - Neutrophile Granulocytes - Natural Killer Cells - Lymphocytes - Opsonines - Vaccination

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