Beinker N K, Voigt M D, Arendse M, Smit J, Stander I A, Kirsch R E
MRC/UCT Liver Research Centre, Groote Schuur Hospital, Cape Town, South Africa.
J Hepatol. 1996 Nov;25(5):633-8. doi: 10.1016/s0168-8278(96)80231-5.
BACKGROUND/AIMS: In hepatitis C, iron depletion may improve serum aminotransferases and the response to interferon, but it is not known whether inflammation and fibrosis correlate with hepatic iron content. Our aim was to establish whether hepatic iron content correlates with histological and serum indices of hepatic inflammation and fibrosis in hepatitis B and C.
Total hepatic iron was measured using computerized histomorphometry, and hepatic inflammation and fibrosis using a modified Knodell score, on histological slides from 31 patients with chronic hepatitis B and 38 with hepatitis C.
Total hepatic iron was similar in the hepatitis B and C groups (0.82 +/- 1.72% and 0.56 +/- 1.12%; mean +/- SD). No iron was detectable in 11 patients with hepatitis B and 13 with hepatitis C. Alanine aminotransferase (85.96 +/- 67.1 vs 44.2 +/- 39.7 p < 0.05), aspartate aminotransferase (93.8 +/- 75.6 vs 47 +/- 33.5 IU/ml p < 0.05) and histological inflammatory score (9.33 +/- 3.51 vs 7.79 +/- 3.3 p = 0.07) were increased in those with stainable hepatic iron compared to those without. However, where iron was present, no association was found between the amount of hepatic iron and inflammatory or fibrosis scores. In hepatitis C, fibrosis was minimal in 77% of patients if iron was absent vs 24% with iron present, while marked fibrosis was present in 56% with iron vs 15% without iron (p < 0.01, Fisher's exact test).
Hepatic iron is associated with increased hepatic inflammation in chronic hepatitis B and hepatitis C and with high fibrosis scores in hepatitis C. There is a threshold effect, and once present, increasing iron does not correlate with increasing inflammation or fibrosis.
背景/目的：在丙型肝炎中，铁耗竭可能改善血清转氨酶及对干扰素的反应，但炎症和纤维化是否与肝铁含量相关尚不清楚。我们的目的是确定肝铁含量是否与乙型和丙型肝炎的肝脏炎症和纤维化的组织学及血清指标相关。
采用计算机化组织形态计量学测量31例慢性乙型肝炎患者和38例丙型肝炎患者肝组织切片中的肝总铁含量，并用改良的Knodell评分评估肝脏炎症和纤维化程度。
乙型肝炎组和丙型肝炎组的肝总铁含量相似（分别为0.82±1.72%和0.56±1.12%；均值±标准差）。11例乙型肝炎患者和13例丙型肝炎患者未检测到铁。与无肝铁染色者相比，有肝铁染色者的丙氨酸转氨酶（85.96±67.1对44.2±39.7，p<0.05）、天冬氨酸转氨酶（93.8±75.6对47±33.5 IU/ml，p<0.05）和组织学炎症评分（9.33±3.51对7.79±3.3，p = 0.07）升高。然而，在有铁存在的情况下，未发现肝铁含量与炎症或纤维化评分之间存在关联。在丙型肝炎中，无铁患者77%的纤维化程度较轻，而有铁患者为24%；有铁患者56%存在明显纤维化，无铁患者为15%（p<0.01，Fisher精确检验）。
肝铁与慢性乙型肝炎和丙型肝炎的肝脏炎症增加以及丙型肝炎的高纤维化评分相关。存在阈值效应，一旦存在，铁含量增加与炎症或纤维化增加无关。
