Arocha R, Pérez Machado L, Hamana N
Servicio de Gastroenterología, Hospital Dr. Ildemaro Salas, IVSS, Caracas.
G E N. 1990 Jan-Mar;44(1):15-20.
24 patients with alcoholic intake were classified according to the amount of alcohol ingestion; clinical symptoms and signs, liver function tests (bilirubin, aminotransferases and prothrombin time) were analyzed. In all patients a percutaneous liver biopsy was performed and tissue stained by hematoxylin-eosin, wilder reticulin and Mallory trichromic. 9 Histologic criteria were analyzed. 4 groups according to the histology were identified. Group 1 (5 patients) hepatic fibrosis and/or fatty liver. Group 2 (5 patients) alcoholic hepatitis. Group 3 (10 patients) cirrhosis. Group 4 (4 patients) normal. 20% of patients with fatty liver, 80% of alcoholic hepatitis and 100% of cirrhotics referred ingestion or more than 160 g of ethanol and important correlation between liver histological damage and alcohol ingestion. Telangiectasia was the most common clinical finding and present in all hepatitis, 70% of cirrhotics and only 20% of fatty livers. Hemosiderosis was found in 60% of cirrhotics and in alcoholic hepatitis. Only 40% of patients with fatty liver and inflammatory cells while this was evident in all patients with alcoholic hepatitis and those with cirrhosis. Mallory bodies were identified in only 20% of cirrhotics and in none of the alcoholic hepatitis. The results suggest that there are significant differences from a histological and clinical point of view that distinguish alcoholic liver disease as seen in Venezuela from that reported in other countries.
24名有酒精摄入的患者根据酒精摄入量进行分类;分析了临床症状和体征、肝功能检查(胆红素、转氨酶和凝血酶原时间)。所有患者均进行了经皮肝活检,组织用苏木精-伊红、怀尔德网状纤维和马洛里三色染色。分析了9项组织学标准。根据组织学确定了4组。第1组(5例患者)为肝纤维化和/或脂肪肝。第2组(5例患者)为酒精性肝炎。第3组(10例患者)为肝硬化。第4组(4例患者)正常。脂肪肝患者中有20%、酒精性肝炎患者中有80%、肝硬化患者中有100%报告摄入乙醇量为160克或更多,且肝脏组织学损伤与酒精摄入之间存在重要关联。毛细血管扩张是最常见的临床发现,在所有肝炎患者、70%的肝硬化患者和仅20%的脂肪肝患者中出现。60%的肝硬化患者和酒精性肝炎患者中发现有含铁血黄素沉着。只有40%的脂肪肝患者有炎性细胞,而在所有酒精性肝炎患者和肝硬化患者中炎性细胞都很明显。仅20%的肝硬化患者中发现有马洛里小体,酒精性肝炎患者中均未发现。结果表明,从组织学和临床角度来看,委内瑞拉所见的酒精性肝病与其他国家报告的情况存在显著差异。