Dworkin B M, Stahl R E, Giardina M A, Wormser G P, Weiss L, Jankowski R, Rosenthal W S
Am J Gastroenterol. 1987 Mar;82(3):231-6.
To assess the spectrum of hepatic abnormalities in acquired immune deficiency syndrome (AIDS), we reviewed clinical, biochemical, and pathological material in 32 patients with AIDS. Eight-four percent of AIDS cases had a history of intravenous drug abuse. Ninety percent of AIDS patients has some liver biochemical abnormality at the first presentation of illness. During the course of AIDS, significant (p less than 0.05, paired Student's t test) rises in alkaline phosphatase and bilirubin occurred, without rises in aminotransferases. Mean abnormalities were mild, reflecting approximately 2-fold increases over baseline. Liver failure was not believed to contribute to the death of any AIDS patient. Pathological findings in AIDS included specific infectious diagnosis in 26%, granulomas in 16%, hemosiderosis in 26%, nonspecific abnormalities in 39%, cirrhosis in 23%, and chronic active hepatitis in 3%. AIDS cases were also compared to 10 selected age, sex, and epidemiologically similar non-AIDS patients. Although granulomas or infections were not seen in our comparison group, only the incidence of chronic active hepatitis was significantly different between the groups. If only those with intravenous drug abuse were studied, then none of 24 AIDS patients versus four of eight non-AIDS cases (p less than 0.005) had chronic active hepatitis. AIDS patients with specific hepatic infections tended to have a higher alkaline phosphatase and aspartate aminotransferase (p less than 0.05) than noninfected cases. However, substantial overlap existed, and no difference in hepatomegaly was noted. Ninety percent of AIDS patients were ingesting at least one potentially hepatotoxic drug. We conclude that AIDS patients have a high incidence of underlying hepatic abnormalities. However, clinical and biochemical abnormalities are similar in our selected liver biopsy patients with intravenous drug abuse with or without AIDS. As expected, AIDS patients have a higher incidence of hepatic granulomas and infections, but these patients were not clearly distinguishable from other AIDS cases. Histological examination showed a wide array of changes by light microscopy, but no specific lesion of AIDS was noted. The low incidence of chronic active hepatitis in this AIDS population may imply that the altered T lymphocyte function in AIDS could influence the course of liver disease in these patients.
为评估获得性免疫缺陷综合征（AIDS）患者肝脏异常的情况，我们回顾了32例AIDS患者的临床、生化及病理资料。84%的AIDS患者有静脉注射毒品史。90%的AIDS患者在首次发病时存在某些肝脏生化异常。在AIDS病程中，碱性磷酸酶和胆红素显著升高（配对t检验，p<0.05），而转氨酶未升高。平均异常程度较轻，约为基线水平的2倍。未发现肝功能衰竭导致任何AIDS患者死亡。AIDS患者的病理表现包括26%有特异性感染诊断、16%有肉芽肿、26%有含铁血黄素沉着、39%有非特异性异常、23%有肝硬化、3%有慢性活动性肝炎。AIDS患者还与10例年龄、性别及流行病学情况相似的非AIDS患者进行了比较。尽管在我们的对照组中未发现肉芽肿或感染，但两组间仅慢性活动性肝炎的发生率有显著差异。若仅研究有静脉注射毒品史的患者，24例AIDS患者中无一例有慢性活动性肝炎，而8例非AIDS患者中有4例有慢性活动性肝炎（p<0.005）。有特异性肝脏感染的AIDS患者的碱性磷酸酶和天冬氨酸转氨酶水平往往高于未感染患者（p<0.05）。然而，两者有很大重叠，且未发现肝肿大方面的差异。90%的AIDS患者至少服用一种潜在肝毒性药物。我们得出结论，AIDS患者潜在肝脏异常的发生率较高。然而，在我们选取的有或无AIDS的静脉注射毒品史肝活检患者中，临床和生化异常情况相似。正如预期，AIDS患者肝脏肉芽肿和感染的发生率较高，但这些患者与其他AIDS患者并无明显区别。组织学检查显示光镜下有广泛的改变，但未发现AIDS的特异性病变。该AIDS人群中慢性活动性肝炎的低发生率可能意味着AIDS患者T淋巴细胞功能的改变会影响这些患者的肝脏疾病进程。
