McGuire B M, Cherwitz D L, Rabe K M, Ho S B
Department of Medicine, University of Minnesota Hospital, Minneapolis, USA.
Mayo Clin Proc. 1997 Feb;72(2):133-9. doi: 10.4065/72.2.133.
In this report, we describe four cases of small-cell carcinoma of the lung manifesting as acute hepatic failure. These cases were noteworthy for the presence of hepatomegaly and substantially increased serum lactate dehydrogenase and uric acid levels. The ratio of normalized serum lactate dehydrogenase to normalized serum alanine aminotransferase from the 4 cases reported herein (mean +/- SE, 3.63 +/- 1.10) was significantly greater than the ratio obtained from the 12 cases of nonmalignant fulminant hepatic failure (mean +/- SE, 0.46 +/- 0.18; P < 0.001). Chest radiographs and abdominal imaging studies showed no neoplastic process in three of the four cases. Postmortem examinations disclosed extensive infiltration of the liver by metastatic small-cell carcinoma of the lung. A review of the literature revealed 13 additional similar cases. We conclude that metastatic small-cell carcinoma of the lung should be considered in cases of acute hepatic failure associated with hepatomegaly, substantially increased lactate dehydrogenase levels in comparison with alanine aminotransferase values, and increased uric acid levels even if imaging studies show no lesion. A liver biopsy done early during the hospital course is appropriate for diagnosis and for prevention of inappropriate transfer of the patient to a liver transplant center.
在本报告中，我们描述了4例表现为急性肝衰竭的肺小细胞癌病例。这些病例的显著特点是存在肝肿大以及血清乳酸脱氢酶和尿酸水平大幅升高。本文报告的4例病例中，标准化血清乳酸脱氢酶与标准化血清丙氨酸氨基转移酶的比值（均值±标准误，3.63±1.10）显著高于12例非恶性暴发性肝衰竭病例的比值（均值±标准误，0.46±0.18；P<0.001）。胸部X线片和腹部影像学检查显示，4例病例中有3例未发现肿瘤病变。尸检发现肝脏有广泛的肺转移性小细胞癌浸润。文献复习发现另外还有13例类似病例。我们得出结论，对于伴有肝肿大、乳酸脱氢酶水平相对于丙氨酸氨基转移酶值大幅升高以及尿酸水平升高的急性肝衰竭病例，即使影像学检查未显示病变，也应考虑肺转移性小细胞癌。在病程早期进行肝活检，有助于诊断并防止不恰当地将患者转至肝移植中心。
