Lefkowitch J H, Mendez L
J Hepatol. 1986;2(3):313-27. doi: 10.1016/s0168-8278(86)80043-5.
One-hundred-forty postmortem liver specimens from patients with cardiac disease or pre-terminal hypotensive shock were examined in order to characterize the histopathologic features of ischemic and congestive hepatic disease. The study group included patients with arteriosclerotic, valvular or hypertensive heart disease, primary pulmonary disease with cor pulmonale, myocarditis, cardiomyopathy, and shock. The hepatic lesions included centrilobular congestion alone (10%), congestion with necrosis (77%), centrilobular necrosis with inflammatory reaction (neutrophil or mononuclear cell) (27%), cardiac sclerosis (48%) and regenerative hyperplasia (23%). Cardiac sclerosis, the most common form of hepatic fibrosis seen, consisted of eccentric thickening or occlusion of the walls of central veins and perivenular scars extending into the lobular parenchyma. Regeneration of liver cells was manifested by either liver-cell plate thickening within a retained cord-like framework or by nodular masses of hepatocytes (nodular regenerative hyperplasia). Only one case of developing cirrhosis was identified in this series. The morphologic features outlined in this study should provide a useful basis for the classification of liver injury in cardiac disease and shock.
对140例患有心脏病或终末期低血压休克患者的肝脏尸检标本进行了检查，以明确缺血性和充血性肝病的组织病理学特征。研究组包括患有动脉粥样硬化性、瓣膜性或高血压性心脏病、原发性肺部疾病合并肺心病、心肌炎、心肌病和休克的患者。肝脏病变包括单纯小叶中心性充血（10%）、充血伴坏死（77%）、小叶中心性坏死伴炎症反应（中性粒细胞或单核细胞）（27%）、心源性硬化（48%）和再生性增生（23%）。心源性硬化是所见肝纤维化最常见的形式，表现为中央静脉壁偏心性增厚或闭塞，以及延伸至小叶实质的静脉周围瘢痕。肝细胞再生表现为在保留的条索状框架内肝细胞板增厚或肝细胞结节状团块（结节状再生性增生）。本系列中仅发现1例发生肝硬化。本研究概述的形态学特征应为心脏病和休克中肝损伤的分类提供有用的依据。
