Lebovics E, Thung S N, Schaffner F, Radensky P W
Hepatology. 1985 Mar-Apr;5(2):293-8. doi: 10.1002/hep.1840050224.
We reviewed the clinical data and hepatic histologic findings of 25 patients with the acquired immunodeficiency syndrome who underwent 29 liver biopsies. Our experience indicates that the only hepatic feature characteristic of acquired immunodeficiency syndrome is serologic evidence of exposure to the hepatitis B virus. The most common histologic finding was macrovesicular steatosis. Granulomas appeared in seven patients and were due to mycobacterial disease (3 patients), histoplasmosis (1 patient), adverse reaction to sulfonamide (2 patients) and unknown causes (1 patient). The clinical indication for liver biopsy was not significantly different in the patients without or with granulomas or with granulomas secondary to mycobacteria or fungi. Mycobacteria were cultured from all histologically positive specimens and one histologically negative specimen. Liver biopsy should be performed in any patient with acquired immunodeficiency syndrome who has unexplained fever, hepatomegaly or abnormal results of serum biochemical liver tests, and all specimens should be stained and cultured for mycobacteria and fungi.
我们回顾了25例获得性免疫缺陷综合征患者的临床资料及肝脏组织学检查结果，这些患者共接受了29次肝脏活检。我们的经验表明，获得性免疫缺陷综合征唯一具有特征性的肝脏表现是血清学证据显示曾接触过乙型肝炎病毒。最常见的组织学表现是大泡性脂肪变性。7例患者出现肉芽肿，病因分别为分枝杆菌病（3例）、组织胞浆菌病（1例）、对磺胺类药物的不良反应（2例）及不明原因（1例）。有无肉芽肿、分枝杆菌或真菌所致肉芽肿患者的肝脏活检临床指征无显著差异。所有组织学阳性标本及1例组织学阴性标本均培养出分枝杆菌。对于任何有不明原因发热、肝肿大或血清肝生化检查结果异常的获得性免疫缺陷综合征患者均应进行肝脏活检，所有标本均应进行分枝杆菌和真菌染色及培养。
