Chan T M, Wu P C, Li F K, Lai C L, Cheng I K, Lai K N
Department of Medicine, University of Hong Kong, Queen Mary Hospital, China.
Gastroenterology. 1998 Jul;115(1):177-81. doi: 10.1016/s0016-5085(98)70380-4.
Fibrosing cholestatic hepatitis is a histological variant of hepatitis B virus infection with a high rate of mortality. We describe a patient who acquired acute hepatitis B virus infection 8 months after renal transplantation. Clinical features of rapidly progressive liver failure, indicated by prolonged prothrombin time (57 seconds) and increased bilirubin (40.4 mg/dL) and ammonia (129 mumol/L) concentrations, were accompanied by an extremely high serum HBV DNA level (2.153 x 10(6) pg/mL). Liver biopsy specimen showed fibrosing cholestatic hepatitis with widespread balloon degeneration of hepatocytes, focal hepatocyte loss, bile stasis, periportal fibrosis, mild lymphocytic infiltration, and strongly positive immunohistochemical staining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen. Lamivudine therapy suppressed HBV DNA to < 10 pg/mL within 4 weeks, which was followed by gradual recovery of liver function from a state of hepatic precoma. Twenty-four months after the onset of hepatitis, the patient had normal prothrombin time and bilirubin, transaminase, and albumin levels. She remained HBsAg positive and hepatitis B e antigen negative. Renal allograft function was stable, with a creatinine level of 1.52 mg/dL. HBV DNA remained suppressed after 22 months of lamivudine therapy. Our experience shows that fibrosing cholestatic hepatitis and liver failure caused by HBV infection can be successfully treated with lamivudine.
纤维淤胆型肝炎是一种乙型肝炎病毒感染的组织学变异型，死亡率很高。我们描述了一名肾移植术后8个月发生急性乙型肝炎病毒感染的患者。临床特征为快速进展性肝衰竭，表现为凝血酶原时间延长（57秒）、胆红素升高（40.4mg/dL）和血氨浓度升高（129μmol/L），同时伴有极高的血清HBV DNA水平（2.153×10⁶pg/mL）。肝活检标本显示为纤维淤胆型肝炎，肝细胞广泛气球样变性、局灶性肝细胞丢失、胆汁淤积、汇管区纤维化、轻度淋巴细胞浸润，乙肝表面抗原（HBsAg）和乙肝核心抗原免疫组化染色呈强阳性。拉米夫定治疗4周内将HBV DNA抑制至<10pg/mL，随后肝功能从肝昏迷前期状态逐渐恢复。肝炎发病24个月后，患者凝血酶原时间、胆红素、转氨酶和白蛋白水平正常。她仍为HBsAg阳性、乙肝e抗原阴性。肾移植功能稳定，肌酐水平为1.52mg/dL。拉米夫定治疗22个月后HBV DNA仍被抑制。我们的经验表明，拉米夫定可成功治疗由HBV感染引起的纤维淤胆型肝炎和肝衰竭。
