Chedid A, Mendenhall C L, Tosch T, Chen T, Rabin L, Garcia-Pont P, Goldberg S J, Kiernan T, Seeff L B, Sorrell M
Gastroenterology. 1986 Jun;90(6):1858-64. doi: 10.1016/0016-5085(86)90253-2.
The significance of megamitochondria in the alcoholic liver injury of humans was investigated as part of a large Veterans Administration cooperative study of the natural history of alcoholic hepatitis. Two hundred twenty patients were clinically stratified into the following three groups according to disease severity using serum bilirubin and prothrombin time as indicators: Group 1 (mild disease), serum bilirubin levels less than 5 mg/dl and prothrombin time prolonged for less than 4 s; group 2 (moderate disease), serum bilirubin levels greater than 5 mg/dl but prothrombin time prolonged for less than 4 s; and group 3 (severe disease), serum bilirubin levels greater than 5 mg/dl and prothrombin time prolonged for greater than 4 s. Megamitochondria were observed in 20% of the patients (45 of 220). Of these, 43 patients were in groups 1 and 2 of severity and only 1 patient belonged in group 3. The association of megamitochondria with cirrhosis was infrequent (33%, 15 of 45 patients). The differences in severity correlated with the differences in mortality: in patients with megamitochondria, only 1 had died at 6 mo compared with 40 deaths in patients without megamitochondria. By 12 mo, there were two deaths in patients with megamitochondria versus 51 deaths in those patients without. No complications were present in 72% of patients with megamitochondria versus 39% for those without. Infection, gastrointestinal bleeding, pancreatitis, hyperglycemia, azotemia, delirium tremens, seizures, and hepatic encephalopathy were all more common in patients without megamitochondria. The patients with megamitochondria appear to represent a subcategory of alcoholic hepatitis with a milder degree of clinical severity, lower incidence of cirrhosis, fewer complications, and good long-term survival.
作为退伍军人管理局对酒精性肝炎自然史进行的一项大型合作研究的一部分，对巨型线粒体在人类酒精性肝损伤中的意义进行了调查。根据疾病严重程度，以血清胆红素和凝血酶原时间为指标，将220例患者临床分为以下三组：第1组（轻度疾病），血清胆红素水平低于5mg/dl且凝血酶原时间延长少于4秒；第2组（中度疾病），血清胆红素水平高于5mg/dl但凝血酶原时间延长少于4秒；第3组（重度疾病），血清胆红素水平高于5mg/dl且凝血酶原时间延长超过4秒。在20%的患者（220例中的45例）中观察到巨型线粒体。其中，43例患者属于严重程度的第1组和第2组，只有1例患者属于第3组。巨型线粒体与肝硬化的关联并不常见（45例患者中有15例，占33%）。严重程度的差异与死亡率的差异相关：在有巨型线粒体的患者中，6个月时只有1例死亡，而没有巨型线粒体的患者中有40例死亡。到12个月时，有巨型线粒体的患者中有2例死亡，而没有巨型线粒体的患者中有51例死亡。有巨型线粒体的患者中72%无并发症，而没有巨型线粒体的患者中这一比例为39%。感染、胃肠道出血、胰腺炎、高血糖、氮质血症、震颤谵妄、癫痫和肝性脑病在没有巨型线粒体的患者中更为常见。有巨型线粒体的患者似乎代表了酒精性肝炎的一个亚类，其临床严重程度较轻，肝硬化发生率较低，并发症较少，长期生存率良好。
