Alkohol und Immunsystem beim Intensivpatienten

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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