Permeabilidade Intestinal em Doentes com Cirrose Hepática: Correlação com Endotoxemia e Níveis Circulantes de TNFα, IL - 1 e IL – 6

 

Susana Mão de Ferro¹, Maria Salazar³, Mariana Machado², Fernando Ramalho², Helena Cortez Pinto²

Serviços de Gastrenterologia ¹IPOLFG, EPE, ²Hospital de Santa Maria, ³Hospital da Força Aérea

Correspondência

 

RESUMO

INTRODUÇÃO: A permeabilidade intestinal (PI) aumentada pode contribuir para a patogénese da cirrose hepática (CH) por aumento da translocação bacteriana e endotoxemia, com consequente elevação dos mediadores inflamatórios. OBJECTIVOS: Avaliar em doentes com CH se existe aumento da PI, e como este se correlaciona com a endotoxemia, resposta imunológica e a sua influência no risco de desenvolvimento de complicações. MÉTODOS: 19 doentes com CH, sem consumo alcoólico activo, e 19 controlos sem evidência de CH. PI avaliada pelo teste da lactulose-manitol (>Lac-Man). Níveis séricos de IL - 1, IL - 6 e TNFα e endotoxemia. RESULTADOS: Permeabilidade intestinal: LAC/MAN: 0,16 ± 0,11 vs 0,40 ± 0,38, p=0,02 e endotoxemia: 0,38 ± 0,29 vs 0,28 ± 0,15 EU/mL, ns, nos doentes e controles respectivamente, sugerindo permeabilidade intestinal aumentada em ambos os grupos. A PI não se correlacionou com os níveis de endotoxemia e indivíduos com varizes esofágicas não apresentaram maior aumento da PI. IL- 1: 2,3 ± 0,3 vs. 1,8 ± 0,4 pg/mL,p = 0,03, IL - 6: 4,1 ± 3,4 vs.1,9 ± 2,2 pg/mL, p = 0,01; e TNF􀀀: 6,2±2,1 vs. 3,7±3,7 pg /mL, p = 0,001, nos doentes em relação aos controlos. CONCLUSÕES: Na cirrose hepática compensada, verificou-se PI e endotoxinemia aumentada, sem correlação com a presença de varizes esofágicas. Observou-se aumento significativo das citocinas circulantes, sem contudo se correlacionarem com o grau de PI ou endotoxemia.

PALAVRAS-CHAVE: Cirrose hepática, permeabilidade intestinal, endotoxemia.

 

Intestinal Permealibity in Patients with Liver Cirrhosis: Correlation with Endotoxemia and Circulating Levels of TNFα, IL - 1 and IL - 6

ABSTRACT

INTRODUCTION: Increased intestinal permeability (IP) may contribute to the pathogenesis of liver cirrhosis (LC), allowing for an increase in bacterial translocation and endotoxemia, with subsequent rise in inflammatory mediators. AIMS: To evaluate IP in patients with LC and its correlation with endotoxemia, cytokine response, and risk of complications. METHODS: 19 patients with LC, without active alcohol consumption, and 19 controls, without evidence of LC. IP was evaluated with the lactulose-manitol test (Lac-Man), and serum levels of endotoxaemia, IL - 1, IL - 6, and TNFα. RESULTS: Intestinal permeability: LAC/MAN: 0.16 ± 0.11 vs 0.40 ± 0.38, p=0.02, and endotoxaemia: 0.38 ± 0.29 vs 0.28 ± 0.15 EU/mL, ns, in patients and controls respectively, suggesting increased permeability in both groups. PI did not correlate with endotoxinemia and individuals with oesophageal varices did not present increased intestinal permeability. IL - 1: 2.3 ± 0.3 vs. 1.8 ± 0.4 pg/mL, p = 0.03, IL - 6: 4.1 ± 3.4 vs. 1.9 ± 2.2 pg/mL, p = 0.01; TNFα: 6.2 ± 2.1 vs. 3.7 ± 3.7 pg /mL, p = 0.001, in patients and controls respectively. CONCLUSIONS: In compensated liver cirrhosis, intestinal permeability and endotoxaemia are increased, with no correlation with the presence of portal hypertension, although with a significant increase in circulating cytokines which did not correlate with the degree of intestinal permeability or endotoxaemia.

KEYWORDS: Liver cirrhosis, intestinal permeability, endotoxaemia.

 

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Correspondência: Susana Mão de Ferro, Serviço de Gastrenterologia, IPOLFG, EPE, R. Prof. Lima Basto 1099-023 Lisboa – Portugal; E-mail: smaodeferro@gmail.com

 

PATROCÍNIOS

Trabalho patrocinado por Bolsa de Investigação da Sociedade Portuguesa de Gastrenterologia. Comunicado sob a forma de Poster na 44th Annual Meetingof the European Association for the Study of the Liver (EASL), 2009, Copenhaga – Dinamarca, e no XXVIII Congresso Nacional de Gastrenterologia, 2008.

 

Recebido para Publicação: 31/03/2010 e Aceite para Publicação: 19/12/2010.