Geubel A P, Baggenstoss A H, Summerskill W H
Gastroenterology. 1976 Sep;71(3):444-9.
Of 125 patients fulfilling preestablished criteria for severe chronic active liver disease (CALD) and enrolled in a prospective trial of treatment, 15 (12%) presented with morphological features of liver biopsy consistent with the diagnosis of both CALD and primary biliary cirrhosis (PBC) syndrome. Customary clinical, biochemical, and immunoserological studies failed to distinguish fully between these conditions. By contrast, early response to treatment with prednisone and/or azathioprine identified two different groups of patients. Five patients failed to respond, whereas 10 improved and this was followed by resolution of all clinical, biochemical, and morphological evidence of disease activity. Analysis of the initial chemical findings and cumulative bile duct counts from multiple biopsies correlated failure to respond with biochemical and morphological features more consistent with PBC than CALD. Responses to treatment can therefore be utilized when indicated for differentiating CALD with cholangitic features from PBC.
在125例符合严重慢性活动性肝病（CALD）既定标准并参加前瞻性治疗试验的患者中，15例（12%）的肝活检形态学特征与CALD和原发性胆汁性肝硬化（PBC）综合征的诊断均相符。常规的临床、生化和免疫血清学研究未能完全区分这些情况。相比之下，对泼尼松和/或硫唑嘌呤治疗的早期反应确定了两组不同的患者。5例患者无反应，而10例患者病情改善，随后所有疾病活动的临床、生化和形态学证据均消失。对初始化学检查结果和多次活检累积胆管计数的分析表明，无反应与更符合PBC而非CALD的生化和形态学特征相关。因此，在需要区分具有胆管炎特征的CALD和PBC时，可利用治疗反应来进行鉴别。
