Ishii K, Furudera S, Kumashiro R, Koga Y, Hamada T, Sata M, Abe H, Tanikawa K
Second Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Alcohol Alcohol Suppl. 1993;1B:97-103. doi: 10.1093/alcalc/28.supplement_1b.97.
Among the patients with alcoholic hepatitis, the patients with severe alcoholic hepatitis (SAH) were distinguished by clinical course, laboratory data and histological findings. The aim of this study was to clarify the clinicopathological features, pathological condition and pathogenesis of SAH. Twenty-four SAH patients were compared with 55 patients with acute type fulminant hepatitis (FH) and the other types of alcoholic liver disease. SAH showed a very poor prognosis with a survival rate of 25% and was complicated by multiple organ failure earlier than FH. IgA class lipid A antibody, endotoxin (Et) and tumor necrosis factor-alpha (TNF-alpha) levels in the blood well reflected the pathological condition and severity of SAH. The white blood cell count in the peripheral blood was thought to be the simplest indicator for the prediction of the prognosis of SAH. In conclusion, SAH involves hyper-endotoxemia due to dysfunction of the reticuloendothelial system in the liver, and cytokines including TNF-alpha and neutrophils play an important role in the severity of liver injury.
在酒精性肝炎患者中，重度酒精性肝炎（SAH）患者通过临床病程、实验室数据和组织学检查结果得以区分。本研究的目的是阐明SAH的临床病理特征、病理状况及发病机制。将24例SAH患者与55例急性型暴发性肝炎（FH）患者及其他类型酒精性肝病患者进行比较。SAH预后极差，生存率为25%，且比FH更早出现多器官功能衰竭。血液中的IgA类脂多糖抗体、内毒素（Et）和肿瘤坏死因子-α（TNF-α）水平很好地反映了SAH的病理状况和严重程度。外周血白细胞计数被认为是预测SAH预后最简单的指标。总之，SAH涉及肝脏中网状内皮系统功能障碍导致的高内毒素血症，包括TNF-α和中性粒细胞在内的细胞因子在肝损伤的严重程度中起重要作用。
