Spitz R D, Keren D F, Boitnott J K, Maddrey W C
Am J Dig Dis. 1978 Dec;23(12):1076-8. doi: 10.1007/BF01072881.
The probable etiology and outcome of bridging hepatic necrosis found on a liver biopsy performed within three months of the onset of clinical illness was evaluated in 42 consecutive patients with this finding. Eighteen of the patients (43%) had a probable drug etiology for their hepatitis. Ten patients had HBSAG-positive acute hepatitis. Fourteen patients had neither drug-induced disease nor proven HBSAg-positive hepatitis. One patient from the drug-induced group died, but the other 17 had complete clinical recovery. Eight of ten in the hepatitis B antigen-postive group cleared their antigen and had complete clinical recovery. Chronic hepatitis developed in two who remained persistently HGSAg positive. Eight of the patients in the group with unknown etiology recovered, while six developed evidence of active chronic liver disease. This incidence of active chronic liver disease is significantly greater than that found in the drug-induced group (P less than 0.02). We conclude that drug-induced hepatitiis accounts for a significant proportion of patients of acute hepatitis who have bridging hepatic necrosis on liver biopsy. However, in these drug-induced cases the finding of bridging hepatic necrosis does not appear to be associated with an increased risk of development of active chronic liver disease.
对42例在临床疾病发作后三个月内进行肝脏活检发现有桥接性肝坏死的连续患者，评估了其可能的病因及预后。其中18例患者（43%）肝炎的病因可能是药物。10例患者为乙肝表面抗原（HBSAG）阳性的急性肝炎。14例患者既没有药物性疾病，也没有确诊的乙肝表面抗原阳性肝炎。药物性肝炎组中有1例患者死亡，其他17例临床完全康复。乙肝抗原阳性组的10例患者中有8例清除了抗原，临床完全康复。2例持续乙肝表面抗原阳性的患者发展为慢性肝炎。病因不明组的患者中有8例康复，6例出现了活动性慢性肝病的迹象。活动性慢性肝病的发生率显著高于药物性肝炎组（P小于0.02）。我们得出结论，药物性肝炎在肝活检时有桥接性肝坏死的急性肝炎患者中占相当比例。然而，在这些药物性肝炎病例中，桥接性肝坏死的发现似乎与发展为活动性慢性肝病的风险增加无关。
