摘要:

AbstractTo determine the histologic pattern of hepatitis C, 54 liver biopsy specimens from 45 patients with a clinicopathological diagnosis of hepatitis C were studied. All patients were seropositive for antibody to hepatitis C virus by second‐generation testing. Both transfusion‐related and sporadic cases were included. More than half the samples showed chronic hepatitis without cirrhosis, whereas 44% showed developing or fully established cirrhosis. A histological pattern of mild chronic hepatitis with portal lymphoid follicles and varying degrees of lobular activity was found in many of the patients. Lymphoid aggregates or follicles were seen in 78% of biopsy specimens, but aggregates, less prominent than in hepatitis C, were also seen in 14 of 27 samples (52%) from patients with hepatitis B. We conclude that a characteristic histological pattern exists in chronic hepatitis C, that this pattern is not always found and that prominent lymphoid follicles, though not unique to hepatitis C, provide a useful diagnostic clue. (Hepatology 1992;15:567

ISSN:0270-9139    

DOI:10.1002/hep.1840150402

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractBefore the availability of serological markers for hepatitis C, the morphological features of this diagnosis, which represents most non‐A, non‐B hepatitis, could not be confirmed. We examined biopsy specimens from 50 patients with chronic hepatitis C and 21 patients with autoimmune chronic hepatitis. Each biopsy specimen was graded on 19 different histological features. The results indicated that at the time of biopsy, the average age of patients with chronic hepatitis C was 46 yr vs. 36 yr for autoimmune chronic hepatitis. Cirrhosis was seen more frequently in autoimmune chronic hepatitis (90%) than in hepatitis C (58%). Features more commonly observed in chronic hepatitis C were bile duct damage (91% vs. 40%), bile duct loss (91% vs. 20%), steatosis (72% vs. 19%) and lymphoid cell aggregation (follicles) within portal tracts (49% vs. 10%). Severe lobular necrosis and inflammation (76% vs. 38%), piecemeal necrosis (81% vs. 10%), multinucleated hepatocytes (29% vs. 6%) and broad areas of parenchymal collapse (76% vs. 6%) were seen more often in autoimmune chronic hepatitis. Exclusion of five patients with autoimmune chronic hepatitis who received immunosuppression before biopsy accentuated these differences. In conclusion, morphological criteria, in addition to serological data, may be useful for differentiating chronic hepatitis C from autoimmune chronic hepatitis, which histologically is a more aggressive disease. (Hepatology 1992;15:572

ISSN:0270-9139    

DOI:10.1002/hep.1840150403

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractTo evaluate the factors determining the severity of chronic hepatitis B virus infection and the interactions of human immunodeficiency virus and hepatitis delta virus infections, we retrospectively analyzed 260 patients, 146 of whom were followed for a mean of 31.4 ± 1.8 mo. Human immunodeficiency virus, hepatitis B virus, and hepatitis delta virus status and aminotransferase activities, histological activity index, alcohol consumption and the prevalence of cirrhosis were investigated. The patients included 54 homosexuals, 19 parenteral drug abusers and 187 subjects with other or unidentified risk factors for exposure to hepatitis B virus.Thirty‐five patients (13%) were positive for antibody to human immunodeficiency virus; 27 were homosexual and 8 were drug abusers. The mean aminotransferase activities, histological activity index and the prevalence of cirrhosis were similar in the human immunodeficiency virus–positive and human immunodeficiency virus–negative subgroups. Actuarial survival was significantly lower in the human immunodeficiency virus–positive group than in the human immunodeficiency virus–negative subjects (p = 0.004); the cause of death was clearly related to liver failure in four of the five human immunodeficiency virus–positive patients and two of the six human immunodeficiency virus–negative subjects who died. To evaluate the factors determining the severity of liver disease, we compared homogeneous subgroups of subjects. Among the homosexual patients, the prevalence of HBeAg and hepatitis B virus DNA, aminotransferase activities and the histological activity index did not differ according to human immunodeficiency virus antibody status. By contrast, human immunodeficiency virus–positive drug abusers had a higher histological activity index than their human immunodeficiency virus–negative counterparts (14.3 vs. 11.1; p = 0.02), despite a similar prevalence of hepatitis delta virus (around 70%) and similar alcohol consumption.In a stepwise logistic regression analysis, risk factor for exposure to hepatitis B virus was the most reliable variable for predicting the histological activity index (p = 0.0002). Age (p<0.0001), excessive alcohol consumption (p = 0.0002) and risk factor for exposure to hepatitis B virus (p = 0.01) were independently predictive of cirrhosis. The group of drug abusers showed both the highest histological activity index and the highest rate of cirrhosis.In contrast to previous studies, these results show the potential severity of chronic hepatitis B virus–related liver disease in human immunodeficiency virus–positive subjects. Indeed, they suggest that human immunodeficiency virus infection does not attenuate and may even worsen hepatitis B virus–related chronic liver damage. They also show the importance of the type of risk factor for exposure to hepatitis B virus in the outcome of chronic hepatitis B virus infection (Hep

ISSN:0270-9139    

DOI:10.1002/hep.1840150404

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractOngoing hepatitis B virus replication in the presence of antibody to HBeAg can be observed in patients with active liver disease. These forms of chronic hepatitis B have been described as having a poor prognosis. We have conducted a randomized controlled trial to assess the efficacy of lymphoblastoid interferon‐α in 60 patients with antibody to HBeAg and hepatitis B virus DNA–positive chronic hepatitis. Patients received 5 million U/m2interferon three times a week for 6 mo, or no treatment. Final evaluation 18 mo after randomization showed hepatitis B virus DNA negativity and ALT normalization in 53% of treated patients and in 17% of controls (p<0.01). The probability of sustained hepatitis B virus DNA loss was significantly higher in treated patients than in controls (p<0.005). Blinded histological assessment revealed improvement in 50% of treated patients compared with 33% of controls. Pretreatment hepatitis B virus DNA and aminotransferase levels and histological appearance were not predictive of response.The results of this trial indicated that marked reduction of viral replication in serum and remission of liver damage can be obtained with lymphoblastoid interferon in about 50% of patients with HBeAg antibody– and HBV DNA–positive chronic hepatitis. This rate of response is higher than that reported previously. (Hepatology 1992;15:

ISSN:0270-9139    

DOI:10.1002/hep.1840150405

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractThis study examined the effect of duration of hepatitis B virus infection on the association between human immunodeficiency virus type‐1 infection and hepatitis B viral replication. Twenty‐five chronic HBsAg carriers were studied. Presence of hepatitis B virus DNA and expression of HBeAg were more frequent among 20 chronic HBsAg carriers positive for human immunodeficiency virus type‐1 antibody compared with five chronic HBsAg carriers negative for human immunodeficiency virus type‐1 antibody, but the associations were not statistically significant. Hepatitis B virus DNA and HBeAg were inversely related to duration of hepatitis B virus infection (p<0.001). Stratifying for duration of hepatitis B virus infection, the presence of viral replication was similar among patients negative and positive for antibody to human immunodeficiency virus type‐1. Hepatitis B virus DNA levels did not increase with the decline of cellular immunity over time. In conclusion, hepatitis B virus replication among chronic carriers may be a function of duration of hepatitis B virus infection rather than of an effect of human immunodeficiency virus type‐1. (Hepatology 1992;

ISSN:0270-9139    

DOI:10.1002/hep.1840150406

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractTwelve patients with recently diagnosed acute viral hepatitis underwent serial99mTc‐galactosyl neoglycoalbumin scanning of the liver (for up to 8 mo). Injection of99mTc‐galactosyl neoglycoalbumin (150 mBq) at a rate of 3.5 mg (50 nmol; 1 ml) revealed that the liver is the exclusive site of tracer uptake. Simulation of99mTc‐galactosyl neoglycoalbumin kinetics allowed quantification of galactosyl neoglycoalbumin binding to human hepatic binding protein. Return of liver function test scores to normal values was associated in two patients with hepatitis A, in four patients with hepatitis B and in two patients with non‐A, non‐B hepatitis virus infection, with increases in hepatic binding protein concentration (up to three times the initial concentration), binding rate constant and hepatic blood flow. In the other four patients (three patients with hepatitis B and one patient with cytomegalovirus infection) a prolonged course of disease was monitored. In the mean, hepatic binding protein increased from 0.41 ± 0.11 μmol/L after onset of acute hepatitis (n = 12) to 0.78 ± 0.21 μmol/L after 6 mo of follow‐up (n = 10) (p<0.001). During this period, binding rate constant (72.4 ± 12.6 vs. 82 ± 11.5 μmol/L/sec; p<0.05) and hepatic blood flow (0.027 ± 0.0051 vs. 0.031 ± 0.0083 L/sec; p<0.05) increased. Hepatic binding protein concentration correlated highly with actual laboratory test results for liver function (r = 0.98; p = 0.0001). We conclude that scintigraphic evaluation of functional liver cell mass using the new receptor‐tracer99mTc‐galactosyl neoglycoalbumin could provide anin vivodiagnostic means of quantifying liver function and assessing liver morphology. In addition, our findings suggest that changes in hepatic binding protein–receptor concentration are likely to occurin vivo.(H

ISSN:0270-9139    

DOI:10.1002/hep.1840150407

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractLiver samples from patients with three different types of liver diseases, alveolar echinococcosis (a dense and irreversible fibrosis), hepatocellular carcinoma and alcoholic cirrhosis, were analyzed for their content in hydroxypyridinium cross‐links found in mature collagen. We demonstrated the presence of small amounts of pyridinoline in control livers (0.27 ± 0.06 pmol/pmol of collagen). Pyridinoline content was increased in fibrotic livers, with the highest values found in patients with alveolar echinococcosis (up to 1.33 pmol/pmol of collagen). The deoxy analogue of pyridinoline was not detected in either normal or fibrotic livers. Pyridinoline levels, expressed as picomoles per picomole of collagen, were similar in all patients with carcinoma (0.7 ± 0.05 pmol/pmol of collagen). They were heterogeneous in patients with alveolar echinococcosis and were particularly high in patients with alcoholic cirrhosis (1.04 ± 0.11 pmol/pmol of collagen). These results demonstrate for the first time the presence of an hydroxypyridinium cross‐link in liver fibrosis and suggest that pyridinoline measurement might be an important criterion in assessing the irreversibility of human liver fibrosis. (Hepatology 1992;15:59

ISSN:0270-9139    

DOI:10.1002/hep.1840150408

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractBeneficial effects of ursodeoxycholic acid in chronic cholestatic liver diseases have been attributed to displacement of hydrophobic bile acids from the endogenous bile acid pool. To test this hypothesis, we determined pool sizes, fractional turnover rates, synthesisiinput rates and serum levels of deoxycholic acid and chenodeoxycholic acid before and 1 mo after the start of treatment with ursodeoxycholic acid (13 to 15 mg/kg body wt/day) in four healthy volunteers and five patients with chronic cholestatic liver diseases (three with primary biliary cirrhosis and two with primary sclerosing cholangitis). Bile acid kinetics were determined by combined capillary gas chromatographyisotope ratio mass spectrometry in serum samples after administration of [2H4] deoxycholic acid and [13C]chenodeoxycholic acid. In healthy volunteers, deoxycholic acid pool sizes decreased during administration of ursodeoxycholic acid by 72%. In patients with cholestatic liver diseases, deoxycholic acid pool sizes before ursodeoxycholic acid treatment were only 13% of those in healthy volunteers and were unaffected by ursodeoxycholic acid treatment. Chenodeoxycholic acid pool sizes were not different in healthy volunteers and in patients with cholestatic liver disease, and were not altered by ursodeoxycholic acid treatment. In both healthy volunteers and patients with cholestatic liver disease, synthesidinput rates and serum levels of deoxycholic acid and chenodeoxycholic acid were not altered by ursodeoxycholic acid treatment. Because in our patients improvement of serum liver tests during short‐term ursodeoxycholic acid treatment was noted without a decrease of the pool sizes of the major hydrophobic bile acids, we conclude that displacement of hydrophobic endogenous bile acids is not the mechanism of action of ursodeoxycholic acid in chronic cholestatic liver disease. (Hepatology 1992; 15603‐6

ISSN:0270-9139    

DOI:10.1002/hep.1840150409

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractTo investigate the diagnostic value of 24‐hr urinarycopper excretion testing after penicillamine challenge in the diagnosis of Wilson's disease, 75 consecutive children referred for a variety of liver problems and in whom parameters of copper metabolism had been investigated were analyzed retrospectively. Seventeen had Wilson's disease, 22 had autoimmune chronic active hepatitis, 6 had primary sclerosing cholangitis, 12 had chronic liver disease of various etiologies, 4 had cryptogenic acute liver failure, 6 had acute hepatitic illnesses and 8 had a variety of disorders featuring normal liver histological appearance. Serum ceruloplasmin and total copper levels were significantly lower in Wilson's disease patients compared with all other groups, but three children with Wilson's disease had normal ceruloplasmin levels and seven had normal total copper levels. No significant difference was found for free serum copper levels and liver copper content between Wilson's disease patients and the other groups. Baseline 24‐hr urinary copper excretion was significantly higher in Wilson's disease patients compared with that of the other patients, but six children with Wilson's disease had levels just above the upper limit of normal, overlapping with values obtained in three children with liver failure, two with acute hepatitis, two with autoimmune chronic active hepatitis and three with primary sclerosing cholangitis. The 24‐hr urinary copper excretion after penicillamine challenge proved the most accurate single diagnostic test; levels more than 25 μmol/24 hr were present in 15 of 17 patients with Wilson's disease, but in only 1 child with liver failure of the 58 with other disorders. The penicillamine challenge is a valuable aid in the diagnosis of Wilson's disease, particularly in children with no Kaiser‐Fleischer rings. (Hepatology 1992; 15:

ISSN:0270-9139    

DOI:10.1002/hep.1840150410

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY

摘要:

AbstractWe studied 23 patients with cirrhosis who had undergone retroperitoneal distal splenorenal shunt without portal‐azygos disconnection more than 2 yr earlier. We investigated the suitability of the Doppler technique (ultrasound + Doppler) to assess the patency and blood flow direction through the portal vein and the distal splenorenal shunt and its correlation with the continuous thermal dilution technique. The study also assessed the influence of the distal splenorenal shunt and time after surgery on portal perfusion and liver function. Ultrasound + Doppler distal splenorenal shunt thrombosis in two patients; however, none was confirmed by continuous thermal dilution. Ultrasound + Doppler flowmetry was possible in 19 patients (83%) (mean, 1.58 ± 0.53 L/min). Distal splenorenal shunt continuous thermal dilution measurements were performed in all patients (100%), (mean, 1.65 ± 0.5 L/min). Good correlation was seen between them (r = 0.66). Ultrasound + Doppler of the portal vein showed a hepatopetal flow in 16 patients (69.9%). Hepatic blood flow was significantly higher in patients with hepatopetal flow (p = 0.003). Hepatic clearance and intrinsic hepatic clearance of indocyanine green were significantly lower in patients with hepatofugal flow. Patients with hepatofugal flow had a higher incidence of chronic encephalopathy. None of the patients with a follow‐up of less than 4 yr exhibited hepatofugal flow, whereas 7 of the 16 patients with a longer follow‐up had hepatofugal flow (43.7%). The difference was statistically significant (p = 0.04). This study suggests that ultrasound + Doppler sonography may provide useful data in the evaluation of the patency and blood flow direction through the portal vein and the distal splenorenal shunt. Direction of portal blood flow and time after surgery significantly affect hepatic portal perfusion and liver function. (Hepatology 1992;15:6

ISSN:0270-9139    

DOI:10.1002/hep.1840150411

出版商:W.B. Saunders    

年代:1992

数据来源: WILEY