Department of Forensic Medicine, Wroclaw Medical University, J. Mikulicza-Radeckiego 4 Str., 50-345 Wrocław, Poland.
Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Borowska 213 Str., 50-556 Wrocław, Poland.
Alcohol Alcohol. 2020 Aug 14;55(5):518-523. doi: 10.1093/alcalc/agaa059.
To study types and incidence of histological changes in liver of people deceased due to harmful use of alcohol.
A retrospective review of medico-legal autopsy of 236 adults who died in the years 2015-2016 due to harmful use of alcohol was done. Histopathological liver samples taken during autopsies were evaluated. Blood alcohol content was analyzed. Serological tests for hepatitis B surface antigen and anti-hepatitis C virus (HCV) were performed.
The most common liver pathology (83.1%) was steatosis, mainly mixed type (50%); 66.9% had high-grade steatosis. Liver fibrosis was detected in 39.4% of cases, with fibrosis of higher than or equal to third grade in 14%, hepatitis in 44.5% and steatohepatitis in 19.1%. Toxic hepatocyte injury features (ballooning degeneration, Mallory-Denk bodies) were found in 20.8% cases and degenerative-damage changes in 41.1%. The correlation between the grade of steatosis and fibrosis (P = 0.0005), toxic injury (0.00000101) and degenerative-traumatic changes (P = 0.00000741) was found. The correlation was found between hepatitis and higher than or equal to third grade steatosis (P = 0.037), cholestasis (P = 0.0139), toxic injury features (P = 2.58 × 10-13), degenerative-damage changes (P = 7.9 × 10-12) and presence of anti-HCV (P = 0.00723) and between progression of fibrosis and presence of toxic injury features (2.28 × 10-19), degenerative-damage changes (P = 4.25 × 10-11) and anti-HCV (P = 0.0263).
Spectrum of histopathological liver changes is broad regardless of sex, and various traits are present in various patterns. Comorbidities have strong influence on the picture of changes in the liver. Exact evaluation how often and what histopathological changes will develop in alcohol liver disease is not possible by reason of variability of external factors.
研究因有害使用酒精而死亡的人群肝脏组织学变化的类型和发生率。
对 2015 年至 2016 年期间因有害使用酒精而死亡的 236 名成年人的医学法律尸检进行回顾性审查。对尸检时采集的肝组织病理学样本进行评估。分析血液酒精含量。进行乙型肝炎表面抗原和抗丙型肝炎病毒（HCV）的血清学检测。
最常见的肝脏病变（83.1%）为脂肪变性，主要为混合性（50%）；66.9%为高级别脂肪变性。39.4%的病例检测到肝纤维化，其中 14%为等于或高于三级纤维化，44.5%有肝炎，19.1%有脂肪性肝炎。在 20.8%的病例中发现了毒性肝细胞损伤特征（气球样变性、Mallory-Denk 小体），41.1%的病例有退行性损伤改变。发现脂肪变性和纤维化程度（P=0.0005）、毒性损伤（0.00000101）和退行性创伤性改变（P=0.00000741）之间存在相关性。发现肝炎与高级别脂肪变性（P=0.037）、胆汁淤积（P=0.0139）、毒性损伤特征（P=2.58×10-13）、退行性损伤改变（P=7.9×10-12）和抗-HCV 阳性（P=0.00723）之间存在相关性，纤维化进展与存在毒性损伤特征（2.28×10-19）、退行性损伤改变（P=4.25×10-11）和抗-HCV 阳性（P=0.0263）之间存在相关性。
无论性别如何，肝脏组织学变化的范围都很广泛，并且存在各种不同的特征。合并症对肝脏变化的情况有很大影响。由于外部因素的可变性，无法准确评估酒精性肝病中会发生何种组织病理学变化以及发生频率。
