Afshani P, Littenberg G D, Wollman J, Kaplowitz N
Gastroenterology. 1978 Dec;75(6):1045-50.
Marked biochemical cholestasis mimicking extrahepatic obstruction may occur in alcoholic liver disease. Twenty-three consecutive hyperbilirubinemic alcoholics who underwent liver biopsy were studied. Comparison of the clinical, laboratory, and histological features was made between patients with no or rare intraductal polymorphonuclear leukocytes, group A (19 cases), and those with polymorphonuclear leukocytes in multiple bile ducts ("microscopic cholangitis"), group B (4 cases). Extrahepatic biliary obstruction was excluded in group B by cholangiography. Group B had significantly higher serum SGOT, bilirubin, alkaline phosphatase, and cholesterol than group A. All group B patients had periductal acute inflammation and severe panlobular cholestasis. However, there was no significant histological difference comparing group A patients with alkaline phosphatase greater than 300 mIU per ml and group B patients, except for the presence of intraductal polymorphonuclear inflammation. Therefore, we conclude that microscopic cholangitis is a feature of severe cholestasis which may accompany alcoholic liver injury.
酒精性肝病可能会出现酷似肝外梗阻的明显生化胆汁淤积。对连续23例接受肝活检的高胆红素血症酗酒者进行了研究。对无或罕见导管内多形核白细胞的患者（A组，19例）和多个胆管中有多形核白细胞的患者（“显微镜下胆管炎”，B组，4例）的临床、实验室和组织学特征进行了比较。通过胆管造影排除了B组的肝外胆管梗阻。B组的血清谷草转氨酶、胆红素、碱性磷酸酶和胆固醇显著高于A组。所有B组患者均有导管周围急性炎症和严重的全小叶胆汁淤积。然而，除了导管内多形核炎症的存在外，碱性磷酸酶大于300 mIU/ml的A组患者与B组患者相比，组织学上无显著差异。因此，我们得出结论，显微镜下胆管炎是严重胆汁淤积的一个特征，可能伴随酒精性肝损伤。
