Honsová E, Sperl J
Pracoviste klinické a transplantacní patologie, Transplantcentrum IKEM, Praha.
Cesk Patol. 2011 Apr;47(2):55-8.
Fibrosing cholestatic hepatitis (FCH) is a rapidly progressive, sometimes fatal form of hepatitis B or C in patients who are under immunosuppressive treatment. This condition was originally described in hepatitis B virus-infected recipients after a liver transplantation. It is characterized clinically by cholestatic hepatic dysfunction, and pathologically by marked hepatocyte swelling, cholestasis, periportal peritrabecular fibrosis, and only mild inflammation. Here we present 8 patients with hepatitis B and C related FCH. Three patients developed FCH after liver transplantation, two of them died due to hepatic failure. One recipient of a kidney/pancreas transplant developed "de novo" hepatitis C with features of FCH. He underwent antiviral treatment and survived with good liver function, unfortunately both of his grafts failed. Four patients suffered from a reactivation of their respective hepatitis B infections after chemotherapy treated hematological malignancy. Three of them needed an urgent liver transplantation and survived with good liver function and with a remission of their hematological diseases. The last patient died due to liver failure. Although FCH is a rare variant of viral hepatitis, it should be emphasized that prompt diagnosis is important for the management of patients.
纤维化淤胆型肝炎（FCH）是免疫抑制治疗患者中一种快速进展、有时会致命的乙型或丙型肝炎。这种情况最初是在肝移植后的乙型肝炎病毒感染受者中描述的。其临床特征为淤胆性肝功能障碍，病理特征为明显的肝细胞肿胀、淤胆、汇管区小梁周围纤维化，且仅有轻度炎症。在此，我们报告8例乙型和丙型肝炎相关的FCH患者。3例患者在肝移植后发生FCH，其中2例因肝衰竭死亡。1例肾/胰腺移植受者发生了具有FCH特征的“新发”丙型肝炎。他接受了抗病毒治疗，肝功能良好地存活下来，但不幸的是他的两个移植物均失败。4例患者在化疗治疗血液系统恶性肿瘤后出现各自乙型肝炎感染的再激活。其中3例需要紧急肝移植，肝功能良好地存活下来，血液系统疾病也得到缓解。最后1例患者因肝衰竭死亡。尽管FCH是病毒性肝炎的一种罕见变异型，但应强调的是，及时诊断对患者的管理很重要。
