Jmelnitzky A, Castelletto R, Rondina A, Sidoti A, Apraiz M, Mincarelli J C, Toledo C, Albuquerque M M, Viñas D
Cátedra de Gastroenterología de Post-grado, Universidad Nacional de la Plata.
Acta Gastroenterol Latinoam. 1990;20(2):81-8.
To evaluate quali-quantitatively ischemic liver injury due to acute cardiocirculatory failure (ischemic hepatitis), and its real clinical signification, 200 out of 1165 autopsy records with ACF clinical diagnosis were selected; 33/200 (16.5%) shown centrilobular necrosis without inflammatory component, accompanied or not by midzonal compromise. Grade IV centrilobular necrosis (50-100% involved lobules) was present in 96.9%, with 15.5% associated midzonal pattern, and 21.2% of confluent type; 2 additional cases with isolated midzonal necrosis (5.7%) were seen. Only six patients (3.0% of ACF patients, and 18.2% of those with histological injury) shown overt clinical liver disease, one of them with a fulminant hepatitis picture (0.5% of ACF, and 3.0% of patients with ischemic necrosis). Bilirubin levels were 3.4-10.2 mg%, and aminotransferases rose up to 540 times over their seric superior normal limits. Centrilobular necrosis involved 100% of lobules in all cases.
为了从质和量两方面评估急性心循环衰竭所致的缺血性肝损伤（缺血性肝炎）及其实际临床意义，我们从1165份有急性心循环衰竭临床诊断的尸检记录中选取了200份；其中33/200（16.5%）表现为无炎症成分的小叶中心坏死，伴有或不伴有中间带损害。IV级小叶中心坏死（累及50 - 100%的小叶）占96.9%，伴有15.5%的中间带模式，以及21.2%的融合型；另外还发现2例孤立的中间带坏死（5.7%）。仅有6例患者（占急性心循环衰竭患者的3.0%，占组织学损伤患者的18.2%）出现明显的临床肝病，其中1例表现为暴发性肝炎（占急性心循环衰竭的0.5%，占缺血性坏死患者的3.0%）。胆红素水平为3.4 - 10.2mg%，转氨酶升高至超过血清正常上限的540倍。所有病例中，小叶中心坏死均累及100%的小叶。
