Vŭrbanov G, Glinkova V
Ter Arkh. 1989;61(11):48-50.
Altogether 108 patients with acute alcoholic hepatitis (AAH) were examined. Of these, 14 patients (13%) presented with the cholestatic pattern of AAH, 45 with extrahepatic cholestasis, and 45 were healthy. As compared with the total patients' group with AAH, the patients with the cholestatic form consumed alcohol in greater amounts. Due to intensive jaundice, 50% of the patients were admitted by error to the infectious clinic and 32% to the surgical one. The disease runs a comparatively grave course, the general conditions gets deteriorated, the body temperature rises, the patient senses pains in the right hypochondrium, skin pruritus is lacking. As compared with other patterns of cholestasis, cholestatic AAH is characterized by a higher thymol test, higher levels of cholesterol, low density lipoproteins, activation of gamma-glutamyl transpeptidase and aspartate aminotransferase and by a lower level of leukocytes, bilirubin, free fatty acids and alkaline phosphatase. Verification of the diagnosis demands the use of certain up-to-date instrumental methods. To identify the cause of cholestasis, great diagnostic significance is attached to echography.
共检查了108例急性酒精性肝炎(AAH)患者。其中,14例(13%)表现为AAH的胆汁淤积型,45例有肝外胆汁淤积,45例健康。与AAH患者总组相比,胆汁淤积型患者饮酒量更大。由于黄疸严重,50%的患者被误诊收入感染科,32%被误诊收入外科。该病病程相对严重,一般状况恶化,体温升高,患者感到右季肋部疼痛,无皮肤瘙痒。与其他胆汁淤积类型相比,胆汁淤积型AAH的特点是麝香草酚试验值更高、胆固醇、低密度脂蛋白水平更高,γ-谷氨酰转肽酶和天冬氨酸转氨酶激活,白细胞、胆红素、游离脂肪酸和碱性磷酸酶水平更低。诊断的核实需要使用某些最新的仪器方法。为了确定胆汁淤积的原因,超声检查具有重要的诊断意义。