Tsega E, Nordenfelt E, Hansson B G, Mengesha B, Lindberg J
Ethiop Med J. 1992 Apr;30(2 Suppl):1-33.
Between July 1986 and April 1989, 334 hospitalized adult Ethiopian patients with chronic liver disease were studied according to a protocol to define their clinical features and to identify risk factors with the aim of preventive intervention. Of these, 14 had chronic hepatitis, 208 cirrhosis and 112 hepatocellular carcinoma (HCC). Both clinical and histological diagnostic criteria were employed. A detailed questionnaire was used to document demographic and clinical data. A common clinical presentation among patients with chronic hepatitis was darkening of the face and hands with or without hypertrichosis of the face and blisters over the dorsi of the hands. This overt or latent form of porphyrea cutanea tarda (PCT) responds to chloroquine. Patients with cirrhosis of the liver commonly present for the first time with ascites, splenomegaly, haematemesis and/or melena from oesophageal varices, and mental changes due to hepatic encephalopathy. Overt or latent forms of PCT are also common features. Peculiar to these cirrhotics is the rarity of spider naevi, gynaecomastia, testicular atrophy, Dupuytren's contracture, parotid gland enlargement and clubbing of the fingers. Exhaustion, loss of appetite, rapid loss of weight, right upper quadrant and/or epigastric pain (all often of less than 6 months' duration, a big, hard, tender and grossly nodular liver with bruit, signs of portal hypertension, and/or hepatic encephalopathy, in a young male with a rapid down hill course characterize the Ethiopian patient with HCC. Serum anti-nuclear factor, anti-mitochondrial anti-bodies and anti-smooth muscle anti-bodies were absent in those with chronic hepatitis and were uncommon in the cirrhotics and HCC cases. One or more hepatitis B virus markers were found in 86% of chronic hepatitis, 88% cirrhosis and 78% HCC and the HBsAg carrier state was found in 36%, 29% and 23%, respectively. Among the HBsAg carriers, HBeAg positivity was less common than anti-HBe but anti-HDV was significantly higher than in the healthy general population. Alphafetoprotein (AFP) levels greater than 500 mg/ml were present in 16 (8%) cirrhotics and 58 (52%) patients with HCC. Histologically, 3 of the chronic hepatitis patients had progressed to cirrhosis, 8 of the cirrhotic patients had chronic active hepatitis and 85% of HCC cases occurred in a background of macronodular cirrhosis. Three cirrhotics developed HCC during follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)
1986年7月至1989年4月期间，按照一项方案对334名住院的成年埃塞俄比亚慢性肝病患者进行了研究，以确定其临床特征并识别危险因素，旨在进行预防性干预。其中，14例为慢性肝炎，208例为肝硬化，112例为肝细胞癌（HCC）。采用了临床和组织学诊断标准。使用详细的问卷记录人口统计学和临床数据。慢性肝炎患者常见的临床表现是面部和手部皮肤变黑，伴有或不伴有面部多毛和手背水泡。这种迟发性皮肤卟啉症（PCT）的显性或隐性形式对氯喹有反应。肝硬化患者首次就诊时通常表现为腹水、脾肿大、食管静脉曲张引起的呕血和/或黑便，以及肝性脑病导致的精神变化。PCT的显性或隐性形式也是常见特征。这些肝硬化患者的特殊之处在于蜘蛛痣、男子女性型乳房、睾丸萎缩、掌挛缩、腮腺肿大和手指杵状变罕见。疲惫、食欲不振、体重迅速减轻、右上腹和/或上腹部疼痛（所有这些症状通常持续时间少于6个月），肝脏大、硬、触痛且有明显结节，伴有血管杂音、门静脉高压体征和/或肝性脑病，在年轻男性中病情迅速恶化，这些是埃塞俄比亚HCC患者的特征。慢性肝炎患者血清中抗核因子、抗线粒体抗体和抗平滑肌抗体均阴性，在肝硬化和HCC病例中也不常见。86%的慢性肝炎、88%的肝硬化和78%的HCC患者检测到一种或多种乙肝病毒标志物，HBsAg携带状态分别为36%、29%和23%。在HBsAg携带者中，HBeAg阳性不如抗-HBe常见，但抗-HDV明显高于健康人群。16例（8%）肝硬化患者和58例（52%）HCC患者的甲胎蛋白（AFP）水平大于500mg/ml。组织学上，3例慢性肝炎患者进展为肝硬化，8例肝硬化患者有慢性活动性肝炎，85%的HCC病例发生在大结节性肝硬化背景下。3例肝硬化患者在随访期间发生了HCC。（摘要截选至400字）
