Zusammenfassung
Chronisch alkoholkranke Patienten haben eine zwei- bis vierfach erhöhte Infektionsrate;
bei Auftreten einer Infektion, haben sie eine verminderte Fähigkeit, diese abzuwehren.
Alkohol scheint proinflammatorische Immunreaktionen über eine Inhibition von TNF-α,
IL-1β, IL-12 und IFN-γ zu vermindern. Dagegen werden antiinflammatorische Prozesse
über IL-10 und TGF-β unterstützt. Bei alkoholkranken Patienten ohne schwere Lebererkrankung
ist das Th1-/Th2-Verhältnis erniedrigt. Sowohl Alkohol als auch Stress führen zu einer
Immunsuppression. Beide Faktoren verstärken sich gegenseitig, deshalb sollte zusätzlicher
Stress vermieden werden. Die alkoholtoxische Leberzirrhose wird mit einer proinflammatorischen
Stimulation, vor allem TNF-α-, und Th1-assoziierten Zytokinen in Verbindung gebracht.
Die Symptomatik einer bestehenden hepatischen Enzephalopathie könnte durch proinflammatorische
Zytokine wie TNF-α und IFN-γ, die bei Infektionen zumindest initial erhöht sind, und
durch ein Alkoholentzugssyndrom, bei dem erhöhte freie Tryptophanspiegel nachgewiesen
werden konnten, verschlechtert werden.
Abstract
Chronic alcoholic patients have a 2- to 4-fold increased rate of infection together
with a decreased ability to fight infection. Alcohol seems to reduce proinflammatory
immune reactions by inhibiting TNF-α, IL-1β, IL-12 and IFN-γ. In contrast, antiinflammatory
processes via IL-10 and TGF-β are enhanced. In chronic alcoholics without liver disease
the Th1/Th2 ratio is reduced. Alcohol as well as stress lead to immunosuppression.
As both factors intensify each other, additional stress should be avoided. Alcohol
toxic liver cirrhosis is associated with proinflammatory stimulation, i.e. TNF-α,
and Th-1 associated cytokines. Symptoms of acute hepatic encephalopathy may be worsened
by proinflammatory cytokines such as TNF-α and INF-γ. These cytokines are increased
in the initial phase of an infection, and have been associated with higher Tryptophan
levels during alcohol withdrawal syndrome.
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Prof. Dr. Claudia Spies
Klinik für Anästhesiologie und operative Intensivmedizin · Universitätsklinikum Charité
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