Alcoholic hepatitis with and without alcoholic hyaline.

Sixteen cases of alcoholic hepatitis with alcoholic hyaline (Group I) and 13 cases without alcoholic hyaline (Group II) have been collected since 1970. These were most frequently found in the fifth decade in both groups. One female was found in Group I. Cases of about two-thirds of both groups were comsumers of 110 g or more of alcohol per day. No significant differences except fever and erythrocyte sedimentation rate were found in clinical and laboratory changes between both groups. Fatty change in liver biopsy specimens were more frequently seen in Group I than in Group II. The wedged hepatic venous pressure was markedly elevated in alcoholic hepatitis with cirrhosis and moderately elevated in alcoholic hepatitis without cirrhosis. Wedged hepatic venography showed the main portal trunk and extrahepatic collaterals, namely, reversal of the portal flow or such tendency in 2 out of 5 patients of Group I.     

1-14C]Ethanol breath test in alcoholic liver disease

The activity of ethanol metabolising enzymes was assessed in 51 patients with alcoholic and non-alcoholic liver disease using tracer doses of [1-14C]ethanol and measuring 14CO2 excretion in the breath. Alcoholic patients with only fatty infiltration of the liver showed significantly increased activity compared with controls. Comparing alcoholic patients with cirrhosis and a serum albumin greater than 28 g/l, activity in those with a recent history of continued heavy drinking was significantly greater than in patients who had abstained from alcohol. In addition, both groups of alcoholic cirrhosis showed significantly more activity than patients with non-alcoholic cirrhosis. The activities of patients with acute alcoholic or viral hepatitis were normal when their prothrombin times were less than 7 sec prolonged, but were reduced when prolongation exceeded 7 sec. These results demonstrate that in chronic alcoholic liver disease, even with cirrhosis, alcohol can still increase the activity of ethanol oxidising enzymes provided hepatic function remains adequate. However, this response is lost in acute liver damage and in chronic alcoholic disease with severe hepatic dysfunction.     

Evaluation of hepatic venous balloon occluder to estimate portal pressure

The hepatic venous balloon occluder method of estimating portal venous pressure (PVP) was evaluated in cats and dogs, during basal state and active vasoconstriction, and during passive presinusoidal resistance elevation in cats. In the dog, the balloon catheter measured a pressure not different from PVP when the balloon was inflated both in basal state and during active vasoconstriction induced by hepatic nerve stimulation, intraportal infusion of histamine or norepinephrine, regardless of whether the balloon was distal or proximal to hepatic venous sphincters. In the cat, the inflated balloon measures a pressure not different from PVP in basal state but slightly overestimated PVP during nerve stimulation or norepinephrine infusion in some protocols. Blood clots were injected intraportally in cats to produce a pure, passive presinusoidal resistance as shown by unchanged intrahepatic pressure but elevated PVP. The balloon method accurately measured PVP in this condition and clearly cannot differentiate pre- from postsinusoidal resistance sites in cats or dogs. The balloon method and the classical wedged pressure method will represent PVP when resistance is primarily postsinusoidal; they provide different measurements when resistance is presinusoidal, the wedged method representing intrahepatic pressure but the balloon method reflecting portal pressure. These differences require confirmation in human presinusoidal cirrhosis.     

Hemodynamic effects of dobutamine in patients with alcoholic cirrhosis

The effects of dobutamine infusion on cardiac output, hepatic blood flow, and the gradient between wedged and free hepatic venous pressures were studied in 14 patients with alcoholic cirrhosis. Cardiac output rose from 5.8 +/- 1.2 l/min (mean +/- SD) to 7.1 +/- 1.5 l/min. Hepatic blood flow and the gradient between wedged and free hepatic venous pressures did not change significantly during the dobutamine infusion (1.360 +/- 0.510 l/min to 1.446 +/- 0.502 l/min and 17.7 +/- 4.9 mm Hg to 17.9 +/- 3.7 mm Hg). We conclude that in alcoholic cirrhotic patients, dobutamine increased cardiac output as a result of increased heart rate and that there were no significant changes in percentage of cardiac output distributed to the liver.     

Hepatitis B antigens and antibodies in asymptomatic carriers and in chronic liver diseases.

88% of asymptomatic hepatitis B surface antigen (HBsAg) carriers and 97% of HBsAg positive patients with chronic hepatitis or non-alcoholic liver cirrhosis showed high titers of antibody to hepatitis B core antigen (anti-HBc). A high titer of anti-HBc, thus suggested to be an indicator of persistent hepatitis B virus infection, was found rarely in seronegative patients with chronic hepatitis, non-alcoholic cirrhosis, or alcoholic liver diseases. It was not revealed in idiopathic portal hypertension or Budd-Chiari syndrome. In asymptomatic HBsAg carriers of 20--29 years of age, hepatitis B e-antigen (HBeAg) was significantly more frequently found in males than in females. There were differences in sex ratio, age, and history of blood transfusion between B type and non-B type of chronic hepatitis and non-alcoholic liver cirrhosis.     

Effect of liver disorders on ethanol elimination and alcohol and aldehyde dehydrogenase activities in liver and erythrocytes

1. Liver biopsies were performed in healthy control subjects and in subjects with alcoholic and non-alcoholic liver disease in order to examine alcohol dehydrogenase (ADH; EC 1.1.1.1) and aldehyde dehydrogenase [ALDH; aldehyde dehydrogenase (NAD+); EC 1.2.1.3] activities. Erythrocyte ALDH and ethanol metabolism were also investigated in the same subjects. 2. Fifteen per cent of the subjects studied (seven of 48 subjects tested) presented atypical ADH activity, characterized by elevated activity at pH 7.4 or 8.8 compared with that found in subjects with the usual ADH form. However, the ethanol elimination curves obtained in two subjects with atypical ADH were indistinguishable from the kinetics of the group with normal ADH. Subjects displaying atypical ADH activity showed normal liver and erythrocyte ALDH activities. 3. Considering only the subjects with the normal ADH form, hepatic ADH activity was unaltered in subjects with non-alcoholic liver disease (chronic hepatitis or cirrhosis) and in those with alcoholic steatosis. Subjects with alcoholic hepatitis or alcoholic cirrhosis showed a lower ADH activity compared with the healthy control group. 4. In spite of the changes detected in subjects with alcoholic liver disease, curves of blood ethanol concentration after oral administration of 0.4 g of ethanol/kg were indistinguishable between the alcoholic hepatitis group and the control group. 5. Hepatic ALDH activity, assayed at 300 mumol/l acetaldehyde, was found to be diminished in all liver pathologies investigated, regardless of their aetiology. Nevertheless, erythrocyte ALDH activity was not modified in subjects with non-alcoholic or alcoholic liver disease. As a result of these findings, no relationship was found between hepatic and erythrocyte ALDH.(ABSTRACT TRUNCATED AT 250 WORDS)     

Localization of T and B cells and alpha fetoprotein in hepatic biopsies from patients with liver disease.

Peripheral blood and hepatic tissue T- and B-lymphocyte distributions, serum alpha fetoprotein (AFP) concentrations, and hepatic AFP were studied in 46 patients undergoing diagnostic percutaneous liver biopsy. The patients included 26 with alcoholic liver disease, 13 with nonalcoholic hepatitis or cirrhosis, and 7 with either normal histology or minor nonspecific changes. Serum AFP was determined by radioimmunoassay and hepatic tissue AFP by indirect immunofluorescence. Peripheral blood T lymphocytes were identified by the sheep red-cell rosette technique; and B lymphocytes by fluoresceinated anti-immunoglobulin antisera and IgG aggregates. Tissue identification of T lymphocytes was accomplished using an extensively absorbed rabbit antihuman thymocyte antiserum and indirect immunofluorescence; tissue B lymphocytes were identified using pepsin F (ab')2 fragments of rabbit IgG antibodies to human immunoglobulins. T lymphocytes predominanted in hepatic lymphoid infiltrates from patients with alcoholic liver disease (91+/-4%), whereas in patients with chronic active or chronic persistant hepatitis, viral hepatitis, or cryoptogenic cirrhosis proportions of T and B lymphocytic infiltrates were similar (50+/-15%). Hepatic tissue AFP was detected in 9 of 18 patients with alcoholic hepatitis; serum AFP concentration was increased in only 1 of these 9 patients. Tissue AFP was not observed in the remaining biopsy material nor were serum AFP concentrations increased. Peripheral blood T-cell numbers were significantly decreased in patients with alcoholic liver disease (P less than 0.01) and in nonalcoholic hepatitis or cirrhosis (P less than 0.025). A close relationship between peripheral blood T-lymphocytopenia and hepatic T-cell infiltrates was observed in patients with alcoholic liver disease; this relationship was less apparent in patients with nonalcoholic hepatitis or cirrhosis.     

Possible deleterious hemodynamic effect of nifedipine on portal hypertension in patients with cirrhosis

The acute effects of nifedipine, 10 mg administered sublingually, were studied in 10 patients with alcoholic cirrhosis. Nifedipine significantly increased cardiac output and reduced systemic vascular resistance. Nifedipine also increased the hepatic venous pressure gradient by 15% (P less than 0.01). Hepatic blood flow and azygos blood flow did not change significantly. It is suggested that nifedipine increases portal pressure and thus may be deleterious to patients with portal hypertension.     

肝硬化门脉高压患者入肝血流的超声评价

目的观测肝硬化门脉高压患者入肝血管(肝动脉、门静脉)血流动力学,探讨其与Child-Pugh肝功能分级、临床预后的关系.方法应用彩色多普勒超声分别检测35例正常健康人和37例肝硬化门脉高压患者的人肝血管的血流参数,分析肝硬化门脉高压入肝血管血流动力学参数与肝硬化分级关系.结果肝硬化门脉高压患者门静脉内径增宽,血流速度下降,充血指数增高,肝动脉血流阻力增高,与对照组有明显差异;肝硬化门脉高压患者Child-Pugh肝功能分级与门静脉内径无显著差异(P＞0.05),Child C级门静脉血流量显著减少,Child肝功能分级与门静脉的充血指数有关.结论测定入肝血管血流动力学参数有助于判断肝硬变门脉高压症的预后,为临床诊治提供依据.     

gamma-Glutamyl transpeptidase activity in liver disease: serum elevation is independent of hepatic GGTP activity

gamma-Glutamyl transpeptidase activity was measured in liver and serum from 110 patients undergoing diagnostic liver biopsy, including patients with alcoholic liver disease, fatty liver not due to alcohol, primary biliary cirrhosis, persistent hepatic disease, chronic active hepatitis and normal livers. Serum gamma-glutamyl transpeptidase was markedly elevated in patients with alcoholic liver disease and primary biliary cirrhosis while mean hepatic gamma-glutamyl transpeptidase activity was significantly increased only in the alcoholic liver disease group. There was considerable overlap of individual enzyme values among the different disease groups. There was no inhibitors or activators of liver gamma-glutamyl transpeptidase in any of these disorders. The increased liver activity was not related to the degree of hepatic fibrosis or cirrhosis. There was no correlation between hepatic and serum gamma-glutamyl transpeptidase activity. Hepatic and serum gamma activities were equally increased in individuals with alcoholic liver disease whether or not they were drinking at the time of the study. The data suggest that increased hepatic gamma-glutamyl transpeptidase activity is neither specific for alcoholic liver disease nor essential for serum GGTP to be elevated.     

基于纹理特征的多序列MRI的肝硬化识别研究

目的 采用基于纹理特征的十倍交叉验证法的神经网络分类器,探讨多序列MRI在肝硬化诊断识别中的价值。方法 将5个序列MR图像（T1WI、T2WI、增强动脉期、门静脉期和平衡期）分成正常肝脏组、较早期肝硬化组及中晚期肝硬化组,手动获取ROI;采用灰度共生矩阵提取ROI的56个纹理特征参数;采用十倍交叉验证法的BP网络分类器分别分类识别3组肝脏组织。结果 门静脉期图像对正常肝脏、较早期肝硬化及中晚期肝硬化的分类效果最好,正确率为87.62%（92/105）,T2WI分类效果最差,正确率为78.33%（47/60）,T1WI、动脉期和平衡期图像居两者之间。结论 采用基于纹理特征的十倍交叉验证法的神经网络分类器可以区分正常肝脏、较早期和中晚期肝硬化MRI;在基于多序列MRI的肝硬化识别研究中,门静脉期图像有可能成为首选。     

Effect of peroral administration of isosorbide dinitrate on portal pressure and blood flow in patients with cirrhosis of the liver

The effect of slow-release isosorbide dinitrate, given orally four times daily for 14 days, on the portal circulation was studied in 10 patients with liver cirrhosis and oesophageal varices. Mean arterial pressure and heart rate were not influenced significantly by isosorbide dinitrate. Statistically significant dilation of the portal vein by 11.9% and an increase in blood flow velocity by 35.4% and in portal blood flow rate by 54.3% were observed at the end of therapy. The average wedged hepatic vein pressure was 32.9 mmHg before therapy and after therapy it was decreased to 60.5%. The slight decrease observed in free hepatic vein pressure was not statistically significant. Before treatment the portohepatic gradient was four times above normal and after therapy it fell to 9.5 mmHg. The results indicate that, in patients with portal hypertension, an improvement in haemodynamics can be achieved by the use of isosorbide dinitrate. This improvement may lead to the prevention of bleeding from oesophageal varices.     

尿毒症合并肝硬化门脉高压患者的腹腔置管术

目的探讨尿毒症合并肝硬化门脉高压患者腹腔置管术的手术方式及术后腹腔积液的处理方式。方法6例尿毒症合并肝硬化门脉高压患者行腹腔置管术,术中采用“荷包缝合-切开腹腔-植入腹膜透析管-关闭腹腔”的手术方式,术后控制腹膜透析液入量和出量并观察腹腔积液量的变化情况。结果6例患者在手术中腹腔积液丢失量为100ml～600ml,术中生命体征平稳。术后5～15天达到腹腔积液达到控制,且未出现其他合并症。结论尿毒症合并肝硬化门脉高压患者行腹腔置管术是可行的。     

64排螺旋CT血管造影评价肝硬化血管改变及侧支循环

目的 探讨MSCTA评价肝硬化肝脏血管的异常改变及侧支循环形成的价值。 方法 对168例肝硬化患者(肝硬化组)及120例无肝硬化的患者(对照组)行肝区三期MSCTA,应用MIP和VR进行重建,并对获得的图像进行对照分析。 结果 肝硬化组和对照组门静脉1级和肝静脉1级血管的显示差异无统计学意义(P分别为0.51、0.08),肝动脉、门静脉、肝静脉分级显示差异均有统计学意义(P<0.01)。肝硬化组肝动脉、门静脉起始部增粗85例,分支纤细、纡曲98例,门静脉癌栓形成9例,海绵变性8例,肝动脉持续显影55例、门静脉持续显影57例;对照组3例肝动脉、门静脉起始部增粗,2例分支纤细、纡曲,4例肝动脉持续显影,3例门静脉持续显影。肝硬化组交通支开放总数258支,其中食管胃底静脉曲张196例(196/258,75.97%),对照组仅2例见腹膜后分流。 结论 64排CT三期血管成像可准确、全面显示肝 硬化血管的异常改变及门体分流,尤其能较早、较全面地显示食管胃底静脉曲张,为临床提供更多可靠的诊断和治疗依据。     

Erythrocyte aldehyde dehydrogenase activity in alcoholic subjects and its value as a marker for hepatic aldehyde dehydrogenase in subjects with and without liver disease

Erythrocyte aldehyde dehydrogenase activity was assayed in actively drinking alcoholics, patients with alcoholic liver disease who claimed to be abstaining, patients with non-alcoholic liver disorders and normal controls. Hepatic cytosolic aldehyde dehydrogenase was also assayed in the majority of the subjects. Actively drinking alcoholics had significantly lower erythrocyte aldehyde dehydrogenase activity than controls (P less than 0.01) but abstaining alcoholic liver disease and non-alcoholic liver disorder subjects did not. There was a significant correlation between erythrocyte and hepatic cytosolic aldehyde dehydrogenase activity in the control group (r = 0.94, P less than 0.05) but not in the other study groups.     

Effect of angiotensin-ll blockade on systemic and hepatic haemodynamics and on the renin-angiotensin-aldosterone system in cirrhosis with ascites

We have studied the effect of angiotensin-II blockade with saralasin on the cardiovascular and hepatic hemodynamics and on the renin-angiotensin-aldosterone system in fourteen patients with cirrhosis and ascites. Control measurements showed that most of the patients had a low mean arterial pressure, high plasma volume, normal or high cardiac index, low peripheral resistance and high plasma renin activity and aldosterone concentration. The wedged hepatic venous pressure was increased in each patient and the estimated hepatic blood flow was normal in most of them. Overall, saralasin induced a significant reduction of the mean arterial pressure, cardiac index and peripheral resistance. The decrease of the peripheral resistance was greater than that of the cardiac index. Six of the patients developed a marked reduction of the mean arterial pressure with low doses of saralasin (1--2.5 microgram/kg/min), and they had significantly higher plasma renin activity and lower mean arterial pressure than the remaining eight patients who showed a slight or no hypotensive response in spite of infusing saralasin up to a dose of 10 micrograms/kg/min. Overall, the decrease of the mean arterial pressure correlated directly with the baseline values of plasma renin activity. Angiotensin-II blockade induced a significant reduction of the wedged hepatic venous pressure. The hepatic blood flow did not show any significant change. The decrease of the wedged hepatic venous pressure was directly related to the reduction of the mean arterial pressure and also to the control plasma renin activity. Our study indicates that in most patients with cirrhosis, ascites and high plasma renin activity, arterial pressure is maintained by the effect of endogenous angiotensin II on the peripheral vasculature, and we suggest that a pre-existing arterial hypotension secondary to an arteriolar vasodilatation is the cause of renin release in these patients. Our results also show that angiotensin-II blockade is accompanied by a reduction of the post-sinusoidal hepatic vascular resistance.     

脉动色素浓度测定法检测吲哚氰绿清除试验在肝储备功能评估中的应用

目的:探讨脉动色素浓度测定法(pulse dye densito graphanalyzer,PDDG)检测吲哚氰绿(ICG)清除试验在肝炎后肝硬化患者术前肝储备功能评估中的作用。方法:用PDDG法进行ICG清除试验,分析其在104例肝炎后肝硬化患者在术后恢复方面与Child-Pugh评分的相关性。结果:吲哚氰绿15min潴留率(ICGR15)在术后腹水、白蛋白用量、利尿剂用量、黄疸等方面与Child-Pugh评分有较好的一致性;同时ICGR15较Child-Pugh评分在术后并发症及治疗方面相关系数更高,相关性更强。结论:PDDG试验是行ICG清除试验检测肝储备功能实用可行的理想方法,能很好地反映肝炎后肝硬化、门脉高压症患者的肝储备功能,对手术后恢复情况有良好的预计性。     

Survival of and hepatoma development in patients with liver cirrhosis

A follow-up study was made on 75 patients with liver cirrhosis. The patients were divided into 5 groups (discontinued alcoholic group, continued alcoholic group, hepatitis B group, male non-alcoholic non-hepatitis B group, and female non-alcoholic non-hepatitis B group). Hepatoma developed in 50% of the hepatitis B group, but in 1-9% of the other 4 groups. Abstinence did not accelerate the development of hepatoma. As for survival after onset of liver cirrhosis, the 1-4-year survival of the female non-alcoholic non-hepatitis B group and the final (8-year) survival of the hepatitis B group appeared to be lower than that of the other groups. Though the survival of the discontinued alcoholic group was seemingly higher that that of the continued alcoholic group, the difference was small and not significant.     

血吸虫性肝硬化的CT表现

目的分析血吸虫性肝硬化的CT表现.方法回顾分析23例血吸虫性肝硬化的CT征象,包括肝脏形态、大小、轮廓、密度、钙化及合并症等.结果 23例中21例肝脏变形,肝左叶增大18例,几乎均有不同程度的钙化,其中线形钙化13例,网格状钙化10例,斑块状钙化8例,门静脉及其属支钙化8例,合并肝癌6例,合并胆囊结石4例.结论肝内钙化和左叶增大为血吸虫性肝硬化的主要CT征象,慢性血吸虫病人的肝癌发生率显著高于非血吸虫病患者,当合并肝内占位时应注意与大型虫卵结节相鉴别.     

Serum beta 2-microglobulin in chronic liver diseases

Serum beta 2-microglobulin was determined in 53 patients with chronic liver diseases. No elevation was shown in fatty liver due to obesity or alcoholism. Serum beta 2-microglobulin was abnormal only in 4% of the patients with chronic hepatitis. Determination of serum beta 2-microglobulin seems not useful for the differential diagnosis between chronic hepatitis and fatty liver due to obesity or alcoholism. Serum beta 2-microglobulin was elevated in 29% of the patients with alcoholic liver cirrhosis, in 41% of those with non-alcoholic liver cirrhosis, and in 75% of those with primary liver carcinoma. The average serum beta 2-microglobulin concentration was significantly higher in non-alcoholic liver cirrhosis than in alcoholic liver cirrhosis. There was a significant correlation between serum beta 2-microglobulin and gamma-globulin concentrations in liver cirrhosis.