Orrego H, Blake J E, Blendis L M, Medline A
Gastroenterology. 1987 Jan;92(1):208-14. doi: 10.1016/0016-5085(87)90861-4.
Liver biopsy specimens (178 percutaneous and 39 transjugular) were assessed from 217 consecutive patients with alcoholic liver disease, 77 noncirrhotics and 140 cirrhotics, whose cases were followed for 5 yr. Cirrhotic patients were categorized into two groups, with and without "hepatitis" using a criteria to define "hepatitis" that included only degrees of inflammation, necrosis, and Mallory bodies that had a prognostic weight in terms of mortality in 1 yr. This classification resulted in a sharp separation between a group of 42 patients with cirrhosis without "hepatitis" and with low mortality, both at 1 yr (7.1% +/- 4.0%) and at 5 yr (31% +/- 7%), and another group of 98 patients with cirrhosis and "hepatitis" and a high mortality both at 1 yr (26.5% +/- 4.5%, p less than 0.01), and at 5 yr (47% +/- 5%, p less than 0.02). Importantly, the 1-yr mortality in patients with cirrhosis and no "hepatitis" was not statistically different from that of patients with no cirrhosis or "hepatitis" (most of whom had only fatty liver) both at 1 yr (6.9% +/- 3.3%) and at 5 yr (24% +/- 6%). There were marked differences in several variables between cirrhosis with and without "hepatitis" [combined clinical and laboratory index: no "hepatitis": 4.9 +/- 0.7, with "hepatitis": 7.8 +/- 0.5, p less than 0.01; score of collagen in space of Disse: no "hepatitis": 2.1 +/- 0.4, with "hepatitis": 3.7 +/- 0.3, p less than 0.01; hepatocyte cross-sectional surface area: no "hepatitis": 682 +/- 51 micron 2, with "hepatitis": 841 +/- 31 micron 2, p less than 0.01]. These findings were more severe in the transjugular group than in the percutaneous group. Collagen in the space of Disse and hepatocyte surface area were not statistically different when cirrhosis without "hepatitis" was compared with a similar no "hepatitis" group of patients having noncirrhotic alcoholic liver disease. In this patient sample the presence of parenchymal nodules and fibrous septa, per se, did not result in an increase in mortality with respect to alcoholic patients without cirrhosis and with no "hepatitis."
对217例连续性酒精性肝病患者的肝活检标本（178例经皮穿刺活检，39例经颈静脉活检）进行了评估，其中77例为非肝硬化患者，140例为肝硬化患者，对这些患者进行了为期5年的随访。肝硬化患者根据是否存在“肝炎”分为两组，采用一种定义“肝炎”的标准，该标准仅包括炎症、坏死程度以及马洛里小体，这些因素在1年死亡率方面具有预后权重。这种分类导致一组42例无“肝炎”的肝硬化患者与另一组98例有“肝炎”的肝硬化患者明显区分开来，前者1年（7.1%±4.0%）和5年（31%±7%）死亡率较低，后者1年（26.5%±4.5%，p＜0.01）和5年（47%±5%，p＜0.02）死亡率较高。重要的是，无“肝炎”的肝硬化患者1年死亡率与无肝硬化或“肝炎”（其中大多数仅有脂肪肝）的患者在1年（6.9%±3.3%）和5年（24%±6%）时相比，无统计学差异。有“肝炎”和无“肝炎”的肝硬化患者在几个变量上存在显著差异[临床和实验室综合指标：无“肝炎”：4.9±0.7，有“肝炎”：7.8±0.5，p＜0.01；狄氏间隙胶原评分：无“肝炎”：2.1±0.4，有“肝炎”：3.7±0.3，p＜0.0
