Kamiyama T, Miyakawa H, Tajiri K, Marumo F, Sato C
Second Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
J Clin Gastroenterol. 1996 Mar;22(2):126-30. doi: 10.1097/00004836-199603000-00011.
To characterize liver dysfunction in patients with cirrhosis after variceal bleeding, we analyzed 50 cirrhotic patients who had bleeding esophageal varices with or without shock. Increases in serum total bilirubin levels by 1.5 times were observed within 24 h in 11 of 12 patients with shock who died > 4 days after hemorrhage but in only one of eight patients with shock who survived (p < 0.01). Increases in serum aspartate aminotransferase and alanine aminotransferase by 2.5 times were observed in six patients in the former group but in none of the latter (p < 0.05). In postmortem livers, hepatocellular degeneration with minimal inflammatory cell infiltration was observed. Ischemic hepatitis is frequently noted in cirrhotic patients with ruptured esophageal varices. Patients with increases in the serum level of total bilirubin and/or aminotransferases within 24 h from onset of hemorrhage should be carefully treated even if hemorrhage is controlled.
为了明确静脉曲张破裂出血后肝硬化患者的肝功能障碍情况，我们分析了50例患有食管静脉曲张破裂出血且伴有或不伴有休克的肝硬化患者。在出血后4天以上死亡的12例休克患者中，有11例在24小时内血清总胆红素水平升高了1.5倍，而在8例存活的休克患者中仅有1例出现这种情况（p<0.01）。前一组中有6例患者血清天冬氨酸转氨酶和丙氨酸转氨酶升高了2.5倍，而后一组中无一例出现这种情况（p<0.05）。在尸检肝脏中，观察到肝细胞变性且伴有极少的炎性细胞浸润。缺血性肝炎在食管静脉曲张破裂的肝硬化患者中经常可见。即使出血得到控制，对于出血后24小时内血清总胆红素和/或转氨酶水平升高的患者也应进行仔细治疗。
