Henrion J, Luwaert R, Colin L, Schmitz A, Schapira M, Heller F R
Département de Gastroentérologie, Hôpital de Jolimont, Haine-Saint-Paul, Belgique.
Gastroenterol Clin Biol. 1990;14(11):836-41.
The authors report 45 episodes of centrilobular liver cell necrosis, called ischemic hepatitis, in 43 cardiac patients. In 75 percent of the episodes, centrilobular liver cell necrosis was preceded by a period of progressive deterioration of myocardiac function. In 100 percent of the episodes, liver cell necrosis occurred after an acute clinical event inducing a transient fall of cardiac output. Shock was observed in only 47 percent of the episodes. The biological hallmarks of this centrilobular liver cell necrosis were a massive increase in serum aminotransferase levels and in 85 percent of the episodes, a decrease in the prothrombine time below 50 percent of control level. The mortality rate, 15 days after admission, was 42 percent. Prognosis was mainly related to cardiac function. The hemodynamic comparison between the 45 episodes of centrilobular liver cell necrosis and 22 cases of cardiogenic shock without liver cell necrosis showed that, besides hepatic ischemia, passive venous congestion of the liver and arterial hypoxemia were also involved in the onset of liver cell necrosis in these cardiac patients. Among these 45 episodes of liver cell necrosis of cardiac origin, a unique case of hepatic necrosis secondary to major hypoxemia and passive venous congestion, despite an high cardiac output was observed and is reported in detail. Accordingly, the appellation "hypoxic hepatitis" seems to be more appropriate than "ischemic hepatitis".
作者报告了43例心脏病患者发生的45次小叶中心性肝细胞坏死，即缺血性肝炎。在75%的病例中，小叶中心性肝细胞坏死之前有一段心肌功能逐渐恶化的时期。在100%的病例中，肝细胞坏死发生在导致心输出量短暂下降的急性临床事件之后。仅47%的病例观察到休克。这种小叶中心性肝细胞坏死的生物学特征是血清氨基转移酶水平大幅升高，85%的病例凝血酶原时间降至对照水平的50%以下。入院15天后的死亡率为42%。预后主要与心脏功能有关。对45次小叶中心性肝细胞坏死发作与22例无肝细胞坏死的心源性休克病例进行的血流动力学比较表明，除肝缺血外，这些心脏病患者肝细胞坏死的发生还涉及肝脏的被动静脉淤血和动脉低氧血症。在这45次心脏源性肝细胞坏死发作中，观察到1例尽管心输出量高但继发于严重低氧血症和被动静脉淤血的肝坏死病例，并进行了详细报告。因此，“低氧性肝炎”这一称谓似乎比“缺血性肝炎”更合适。
