Bertrán X, Planas R, Mate J L, Romeu J, Fernández-Bañares F, Sirera G, Ojanguren I, Doménech E, Cabré E, Gassull M A
Servicio de Aparato Digestivo, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona.
Med Clin (Barc). 1992 Jun 27;99(5):168-71.
The aim of the present study was to describe the spectrum of liver disease in isolated infection by the human immunodeficiency virus and in the acquired immunodeficiency syndrome as well as evaluate whether clinical and/or biological data exist to permit specific diagnosis in liver biopsy.
Liver biopsy was performed in 39 patients with the human immunodeficiency virus (34 via parenteral drug addicts), 22 of whom had established acquired immunodeficiency syndrome.
In 29 cases (74%) a specific histologic diagnosis was obtained with the changes most frequently found being the presence of granulomas (11 patients), mainly in patients with stablished AIDS, and chronic active hepatitis non A non B (10 patients), specially in the cases with isolated infection by the human immunodeficiency virus. Obtaining of a specific diagnosis was associated with an increase in GOT and a decrease of the CD4 lymphocytes and the CD4/CD8 quotient (p = 0.002 in all cases). The existence of established AIDS or prolonged fever was associated with the finding of hepatic granulomas (p = 0.02 and p = 0.002, respectively). The increase in GPT, the absence of stablished AIDS and the absence of prolonged fever was associated to the presence of chronic active hepatitis (p = 0.01, p = 0.002 and p = 0.0002, respectively).
In patients with infection by the human immunodeficiency virus liver biopsy provides diagnostic information in a high percentage of cases. The presence of established AIDS, prolonged fever, and hypertransaminasemia may point towards possible histologic diagnosis.
本研究的目的是描述人类免疫缺陷病毒孤立感染及获得性免疫缺陷综合征中的肝脏疾病谱，并评估临床和/或生物学数据是否有助于肝活检的特异性诊断。
对39例人类免疫缺陷病毒患者（34例为静脉注射吸毒者）进行了肝活检，其中22例已确诊为获得性免疫缺陷综合征。
29例（74%）获得了特异性组织学诊断，最常见的改变是肉芽肿的存在（11例患者），主要见于确诊为艾滋病的患者，以及非甲非乙型慢性活动性肝炎（10例患者），特别是在人类免疫缺陷病毒孤立感染的病例中。获得特异性诊断与谷草转氨酶升高、CD4淋巴细胞及CD4/CD8比值降低相关（所有病例p = 0.002）。确诊为艾滋病或长期发热与肝肉芽肿的发现相关（分别为p = 0.02和p = 0.002）。谷丙转氨酶升高、未确诊为艾滋病及无长期发热与慢性活动性肝炎的存在相关（分别为p = 0.01、p = 0.002和p = 0.0002）。
对于人类免疫缺陷病毒感染患者，肝活检在高比例病例中提供诊断信息。确诊为艾滋病、长期发热及转氨酶升高可能提示可能的组织学诊断。
