Tordjmann T, Grimbert S, Genestie C, Freymuth F, Guettier C, Callard P, Trinchet J C, Beaugrand M
Service d'Hépato-Gastroentérologie, Hôpital Jean-Verdier, Bondy.
Gastroenterol Clin Biol. 1998 Mar;22(3):305-10.
Giant-cell hepatitis is rare in adults and its significance has not been clarified. We report the clinical and histological characteristics and outcome in a group of adult patients with giant-cell hepatitis.
Seventeen patients with giant-cell hepatitis, hospitalized in our unit between 1976 and 1992, were studied retrospectively. Giant-cell hepatitis was defined as at least two hepatocytes with four or more nuclei per cell on liver biopsy. Clinical and biochemical parameters, liver histology, and the serological profile of HAV, HBV, HCV, HIV, HSV, EBV, CMV, and paramyxovirus were evaluated. Paramyxovirus immunochemistry was performed in 6 liver biopsies.
There were 11 females and 6 males, an average of 48 years old (range: 29-80). Four patients had a well-defined etiology: acute hepatitis B infection with a favorable outcome in 2 cases, clometacine induced-hepatitis resulting in death from liver failure in one case, and chronic hepatitis B and C in one patient with AIDS. Among the 13 patients in which the etiology could not be determined, histologically defined acute hepatitis was observed in 8 and chronic hepatitis in 5. Nine patients were treated with immunosuppressive drugs. One patient was lost to follow-up. Eight patients responded to treatment, but 5 patients progressed to cirrhosis between 5 months and 7 years. Two of the 4 patients with unexplained liver disease who did not receive any treatment died of liver failure.
In patient with acute or chronic hepatitis without an identified cause (with or without autoimmune abnormalities), the presence of giant-cell hepatitis seems to have a similar evolution as active autoimmune hepatitis. The poor prognosis of these patients suggests that early immunosuppressive treatment is justified.
巨细胞性肝炎在成人中罕见，其意义尚未阐明。我们报告一组成人巨细胞性肝炎患者的临床、组织学特征及预后。
回顾性研究1976年至1992年间在我科住院的17例巨细胞性肝炎患者。巨细胞性肝炎定义为肝活检时至少两个肝细胞每个细胞有四个或更多核。评估临床和生化参数、肝脏组织学以及甲型肝炎病毒（HAV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人类免疫缺陷病毒（HIV）、单纯疱疹病毒（HSV）、EB病毒（EBV）、巨细胞病毒（CMV）和副粘病毒的血清学特征。对6例肝活检进行了副粘病毒免疫化学检测。
11例女性，6例男性，平均年龄48岁（范围：29 - 80岁）。4例患者病因明确：2例急性乙型肝炎感染预后良好，1例氯美辛所致肝炎导致肝功能衰竭死亡，1例艾滋病患者合并慢性乙型和丙型肝炎。在13例病因不明的患者中，组织学诊断为急性肝炎的有8例，慢性肝炎的有5例。9例患者接受了免疫抑制药物治疗。1例患者失访。8例患者对治疗有反应，但5例患者在5个月至7年之间进展为肝硬化。4例病因不明的肝病患者中，2例未接受任何治疗，死于肝功能衰竭。
在病因不明的急性或慢性肝炎患者（有或无自身免疫异常）中，巨细胞性肝炎的演变似乎与活动性自身免疫性肝炎相似。这些患者预后不良提示早期免疫抑制治疗是合理的。
