Muller A F, Toghill P J
Department of Medicine, University Hospital, Queens Medical Centre, Nottingham.
Gut. 1992 Oct;33(10):1386-9. doi: 10.1136/gut.33.10.1386.
Splenic function was assessed in 42 patients with alcoholic liver disease by counting the percentage of erythrocytes with indentations or pits, seen by differential interference contrast microscopy. These pits represent cellular debris normally removed by the spleen. The findings were compared with 42 age and sex matched controls. Mean (SEM) pitted red cell counts in the patients was 2.7 (0.4)% and in the controls 0.7 (0.07)% (p < 0.001). In all of the eight reformed drinkers (five with biopsy proven cirrhosis), cell counts were normal. Six patients with alcoholic liver disease had had serious infections within the past year. Of these, one had had a recent pneumococcal pneumonia and another of the patients died from overwhelming pneumococcal septicaemia. Both of these patients had evidence of functional hyposplenism as judged by high pitted erythrocyte counts. A total of 18 patients were considered to have pitted red cell counts above the normal, and 11 of these had proven cirrhosis and/or gross ascites. This study is the first to show the presence of functional hyposplenism in alcoholic liver disease and provides further evidence of the predisposition that these patients have to infection. At present, it is unclear whether the hyposplenism is a direct toxic effect of alcohol or the result of cirrhosis; further studies are warranted.
通过计数在微分干涉相差显微镜下观察到的有凹陷或小坑的红细胞百分比，对42例酒精性肝病患者的脾功能进行了评估。这些小坑代表通常由脾脏清除的细胞碎片。将结果与42名年龄和性别相匹配的对照者进行比较。患者中平均（标准误）有凹陷红细胞计数为2.7（0.4）%，对照者为0.7（0.07）%（p<0.001）。在所有8名戒酒者（5名经活检证实为肝硬化）中，细胞计数正常。6例酒精性肝病患者在过去一年内曾发生严重感染。其中，1例近期患肺炎球菌肺炎，另1例死于暴发性肺炎球菌败血症。根据有凹陷红细胞计数高判断，这两名患者均有功能性脾功能减退的证据。共有18例患者被认为有凹陷红细胞计数高于正常，其中11例已证实有肝硬化和/或大量腹水。本研究首次表明酒精性肝病中存在功能性脾功能减退，并为这些患者易发生感染提供了进一步证据。目前尚不清楚脾功能减退是酒精的直接毒性作用还是肝硬化的结果；有必要进行进一步研究。
