Martínez P, González de Etxábarri S, Muñoz J, Santamaría J M, Ereño C, Miguel F
Servicio de Medicina Interna, Hospital de Basurto, Bilbao.
Rev Esp Enferm Dig. 1994 May;85(5):331-7.
To study the spectrum of liver disease in the infection by the human immunodeficiency virus (HIV) and to assess the usefulness and indications of liver biopsy.
Fifty eight HIV seropositive patients (48 intravenous drugs users) were prospectively studied by means percutaneous liver biopsy, because of hepatic biological alterations, hepatomegaly or fever of unknown origin.
Chronic hepatitis was the most common diagnosis, which was found in up to 20 patients (34%) (12 had chronic active hepatitis). Most of them were caused by hepatitis C virus (90%). Hepatic granulomatosis was diagnosed in nine patients (15%), all of them among the subgroup of 19 patients (47%) studied because of fever of unknown origin. Granulomas were thought to be caused by mycobacteria in eight cases (seven tuberculosis, one Mycobacterium avium-intracellulare. Mycobacteria were isolated in culture in four patients whose histologic findings were inspecific. Other representative diagnosis were liver cirrhosis in eight patients, lymphoma in two, alcoholic hepatitis in one and candidiasic hepatitis in one. The diagnostic yield of liver biopsy was 79%.
Liver biopsy is a useful method in the diagnosis of these patients, specially if they present with fever of unknown origin or hepatic biological alterations. In this study chronic active hepatitis was the most common finding, while hepatic granulomatosis was so in patients with fever of unknown origin.
研究人类免疫缺陷病毒（HIV）感染患者的肝脏疾病谱，并评估肝活检的实用性及适应证。
对58例HIV血清学阳性患者（48例静脉吸毒者）进行前瞻性研究，这些患者因肝脏生化指标改变、肝肿大或不明原因发热而接受经皮肝活检。
慢性肝炎是最常见的诊断，多达20例患者（34%）被诊断为此病（其中12例为慢性活动性肝炎）。大多数慢性肝炎由丙型肝炎病毒引起（90%）。9例患者（15%）被诊断为肝脏肉芽肿病，所有这些患者均在因不明原因发热而接受研究的19例患者亚组中（47%）。8例患者的肉芽肿被认为是由分枝杆菌引起（7例为结核病，1例为鸟分枝杆菌-胞内分枝杆菌。4例组织学检查结果不典型的患者在培养中分离出分枝杆菌。其他有代表性的诊断包括8例肝硬化、2例淋巴瘤、1例酒精性肝炎和1例念珠菌性肝炎。肝活检的诊断阳性率为79%。
肝活检是诊断这些患者的一种有用方法，特别是当患者出现不明原因发热或肝脏生化指标改变时。在本研究中，慢性活动性肝炎是最常见的发现，而肝脏肉芽肿病在不明原因发热的患者中最为常见。
