Vergani A, Bovo G, Trombini P, Caronni N, Arosio C, Malosio I, Fossati L, Roffi L, Piperno A
Department of Internal Medicine, S. Gerardo Hospital, Monza, Milan, Italy.
Ital J Gastroenterol Hepatol. 1999 Jun-Jul;31(5):395-400.
Hepatic iron overload is a common but still poorly characterized finding in patients with chronic viral hepatitis.
To evaluate lobular and cellular distribution of iron in patients with chronic viral hepatitis, the relation between hepatic iron distribution, grading and staging, and the frequency of haemochromatosis gene mutations.
Thirty-four patients with chronic viral hepatitis and iron overload; 34 matched chronic viral hepatitis controls without iron overload; 139 healthy controls.
Hepatic iron was assessed by hepatic iron concentration and Deugnier's score, histological grading and staging by Ishak's score, and frequency of haemochromatosis gene mutations by polymerase chain reaction-restriction assays.
Iron deposits were found in hepatocytes (94% of the patients), sinusoidal tracts (88%) and portal cells (59%). In 41%, iron deposits were homogeneously distributed in the hepatic specimen. Hepatocytic iron showed a decreasing gradient from Rappaport's zone 1 to 3. Heavy alcohol intake influenced the distribution rather than the amount of hepatic iron by increasing sinusoidal iron. Haemochromatosis gene mutations were more frequent in chronic viral hepatitis patients with iron overload than in those without iron overload and in healthy controls suggesting they contribute to pathogenesis of hepatic iron accumulation. The correlation between hepatic fibrosis and portal iron supports the fibrogenetic role of iron in chronic viral hepatitis.
肝铁过载在慢性病毒性肝炎患者中很常见，但特征仍不明确。
评估慢性病毒性肝炎患者肝脏中铁的小叶和细胞分布、肝铁分布与分级及分期之间的关系，以及血色素沉着症基因突变的频率。
34例慢性病毒性肝炎合并铁过载患者；34例匹配的无铁过载的慢性病毒性肝炎对照；139例健康对照。
通过肝脏铁浓度和Deugnier评分评估肝脏铁，通过Ishak评分进行组织学分级和分期，通过聚合酶链反应-限制性分析评估血色素沉着症基因突变的频率。
在肝细胞（94%的患者）、窦状隙（88%）和门管区细胞（59%）中发现铁沉积。41%的患者肝脏标本中铁沉积均匀分布。肝细胞铁从Rappaport 1区到3区呈递减梯度。大量饮酒通过增加窦状隙铁来影响肝脏铁的分布而非含量。血色素沉着症基因突变在合并铁过载的慢性病毒性肝炎患者中比在无铁过载的患者及健康对照中更常见，提示它们参与肝铁蓄积的发病机制。肝纤维化与门管区铁之间的相关性支持铁在慢性病毒性肝炎中的促纤维化作用。
