Goritsas C P, Repanti M, Papadaki E, Lazarou N, Andonopoulos A P
Department of Internal Medicine Patras Regional University Hospital, Greece.
J Hepatol. 1997 Mar;26(3):727-30. doi: 10.1016/s0168-8278(97)80441-2.
Although involvement of the hepatic vasculature in patients with polyarteritis nodosa is not unusual, biliary manifestations are very rare. We describe a patient with polyarteritis nodosa presenting with a febrile cholestatic anicteric syndrome. Histological examination of the liver revealed necrotizing arteritis of small hepatic arteries associated with significant lesions of intrahepatic bile ducts of the sclerosing cholangitis type, i.e. fibrous collar around the ducts, periductal inflammation and ductal proliferation. Concomitant nodular regenerative hyperplasia was found, a condition which has rarely been described in association with polyarteritis nodosa. We think that hepatic arteritis compromising arterial blood flow to the liver was responsible for the most likely ischemic nature of the bile duct injury and the nodular regenerative hyperplasia seen in our patient.
虽然结节性多动脉炎患者的肝血管受累并不罕见，但胆汁相关表现却极为罕见。我们报告一例结节性多动脉炎患者，表现为发热性胆汁淤积性无黄疸综合征。肝脏组织学检查显示肝小动脉坏死性动脉炎，伴有硬化性胆管炎类型的肝内胆管显著病变，即胆管周围纤维性套袖、导管周围炎症和导管增生。同时发现伴有结节性再生性增生，这种情况很少与结节性多动脉炎相关联进行描述。我们认为，损害肝脏动脉血流的肝动脉炎是导致我们患者胆管损伤和结节性再生性增生最可能的缺血性质的原因。
