Gervais A, Czernichow B, Grunebaum L, Wiesel M L, Auperin A, Rivalland D, Gabanyi J, Goldstein L, Cazenave J P, Doffoël M
Service d'Hépato-Gastroentérologie, Hôpital Civil, Strasbourg.
Gastroenterol Clin Biol. 1996;20(10):736-42.
Although portal obstruction is a complication in cirrhosis which is usually associated with hepatocellular carcinoma, its precise neoplastic or thrombotic nature is not easy to determine. Serum antiphospholipid antibodies could be involved in thrombosis-related portal obstruction.
The presence of serum anticardiolipid antibodies was investigated by an immunoenzymatic technique in 129 patients with alcoholic cirrhosis, 47 patients with hepatocellular carcinoma with (n = 18) or without (n = 29) portal obstruction, and 82 patients without hepatocellular carcinoma or portal obstruction. Five control groups were included: patients with non alcoholic cirrhosis (n = 21), non cirrhotic alcoholic liver disease (n = 21), chronic viral hepatitis (n = 14), extra-hepatic cholestasis (n = 9), and hypergammaglobulinemia associated with human immunodeficiency virus infection without liver disease (n = 28).
The prevalence of serum anticardiolipid antibodies was 57% in patients with alcoholic cirrhosis, which was significantly different from the prevalence in the control groups which ranged from 0 to 32%. Anticardiolipid antibodies were of IgA isotypes in 90.5% of the cases, mainly related to the degree of liver failure but not to hepatocellular carcinoma or portal obstruction.
In alcoholic cirrhosis, serum anticardiolipid antibodies do not seem to be related to the pathogenesis of portal obstruction in patients with hepatocellular carcinoma. They could rather reflect liver lesions and immunological dysfunctions.
虽然门静脉梗阻是肝硬化的一种并发症，通常与肝细胞癌相关，但其确切的肿瘤性或血栓形成性质并不容易确定。血清抗磷脂抗体可能与血栓形成相关的门静脉梗阻有关。
采用免疫酶技术对129例酒精性肝硬化患者、47例伴有（n = 18）或不伴有（n = 29）门静脉梗阻的肝细胞癌患者以及82例无肝细胞癌或门静脉梗阻的患者进行血清抗心磷脂抗体检测。纳入了五个对照组：非酒精性肝硬化患者（n = 21）、非肝硬化酒精性肝病患者（n = 21）、慢性病毒性肝炎患者（n = 14）、肝外胆汁淤积患者（n = 9）以及与无肝病的人类免疫缺陷病毒感染相关的高球蛋白血症患者（n = 28）。
酒精性肝硬化患者血清抗心磷脂抗体的患病率为57%，与患病率在0%至32%之间的对照组有显著差异。90.5%的病例中抗心磷脂抗体为IgA亚型，主要与肝衰竭程度相关，而与肝细胞癌或门静脉梗阻无关。
在酒精性肝硬化中，血清抗心磷脂抗体似乎与肝细胞癌患者门静脉梗阻的发病机制无关。它们更可能反映肝脏病变和免疫功能障碍。
