Makkar Ravinder P S, Sachdev Gopal Kr, Malhotra Veena
Department of Medicine, Sitaram Bhartia Institute of Science and Research, India.
Intern Med. 2003 Aug;42(8):644-9. doi: 10.2169/internalmedicine.42.644.
It is unknown why most amoebic liver abscess (ALA) cases occur in alcohol drinkers. In experimental studies, the presence of 'iron' potentiates the in-vitro growth of Entamoeba histolytica (E. histolytica), and is also known to increase its in-vivo invasiveness in animal infections. Chronic alcoholism increases the hepatic iron deposition. We hypothesized that ALA occurs more commonly in livers with a high iron load as in alcoholics. To test this hypothesis we compared the levels of iron between ALA and non-ALA cases belonging to alcoholic and non-alcoholic groups.
Out of a total of 48 ALA cases, 34 (70%) were alcoholics and 14 (30%) were non-alcoholics. After applying exclusion criteria, serum iron and liver iron stores were quantified in 20 ALA cases (10 alcoholic and 10 non-alcoholics) and compared with 20 non-ALA cases (10 alcoholics and 10 non-alcoholics).
All patients of ALA had serum iron values within the normal range but higher than non-ALA cases. In the liver tissue, most patients with ALA had higher (grade II or III) iron deposition, than non-ALA cases (mostly grade I). Thus, patients with ALA, with or without alcohol indulgence, had higher iron levels when compared to the non-ALA cases.
It appears that the higher incidence of ALA in alcoholic livers is possibly due to their higher iron content.
多数阿米巴肝脓肿（ALA）病例发生于饮酒者，原因尚不明。在实验研究中，“铁”的存在可增强溶组织内阿米巴（E. histolytica）的体外生长，且已知其会增加该病原体在动物感染中的体内侵袭性。慢性酒精中毒会增加肝脏铁沉积。我们推测，ALA在铁负荷高的肝脏中更常见，如在酒精性肝病患者中。为验证这一假设，我们比较了酒精性和非酒精性组中ALA病例与非ALA病例的铁水平。
在总共48例ALA病例中，34例（70%）为酒精性肝病患者，14例（30%）为非酒精性肝病患者。应用排除标准后，对20例ALA病例（10例酒精性肝病患者和10例非酒精性肝病患者）的血清铁和肝脏铁储备进行定量，并与20例非ALA病例（10例酒精性肝病患者和10例非酒精性肝病患者）进行比较。
所有ALA患者的血清铁值均在正常范围内，但高于非ALA病例。在肝组织中，大多数ALA患者的铁沉积（II级或III级）高于非ALA病例（大多为I级）。因此，与非ALA病例相比，无论是否饮酒，ALA患者的铁水平都更高。
酒精性肝病中ALA发病率较高可能是由于其铁含量较高。
