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Brenner, Charles 圓光大學校 醫科大學 神經精神科學敎室 1996 圓光精神醫學 Vol.12 No.1
이 글은 "훈습"의 의미에 대해 Freud와 다른 사람들이 말한 것을 개관한 것이다. "훈습"과 분석의 관계를 논의하였다.
( DA Brenner ) 대한간학회 2007 추계 학술대회 Vol.13 No.-
Hepatic fibrosis is an outcome of many chronic liver diseases and is characterized by excessive deposition of extracellular matrix (ECM) proteins, especially collagen type I. It is initiated by a cascade of events resulting in hepatocyte damage, recruitment of inflammatory cells to the injured liver, and activation of collagen-producing cells. Hepatic stellate cells (HSC) are a major source of collagen type I. In non-injured liver HSC remain quiescent. In response to injury they undergo activation into collagen-producing myofibroblasts. Cells other than HSC are also implicated in collagen production. Therefore, myofibroblasts originating from small portal vessels proliferate in response to injury and induce synthesis collagen. Moreover, several recent studies proposed that bone marrow derived myofibroblasts and fibrocytes also contribute to ECM deposition in the course of liver fibrosis. Liver injury instigates a complex cross-talk between many hepatic and non-parenchymal cells. Hepatocyte damage often serves as a triggering event in pathogenesis of liver fibrosis. Apoptotic hepatocytes release reactive oxygen species (ROS) and cytokines inducing recruitment of inflammatory cells (lymphocytes and macrophages). Moreover, they release soluble factors (tumor necrosis factor-α [TNF-α], fibroblast growth factor [FGF]), which promote HSC activation and collagen deposition. Activated HSC, in turn, secrete proinflammatory cytokines, up-regulate adhesion molecules and further accelerate recruitment of inflammatory cells. Meanwhile, resident macrophages (Kupffer cells) not only secrete ROS, but also produce profibrogenic cytokines (transforming growth factor [TGF]-β1), which stimulate both HSC and extravasations of white blood cells. Recruitment of T cells to the injured liver shifts local cytokine production towards T helper 2 (Th2) type responses, that is associated with fibrosis.