流行性出血热的肝脏损害(附35例报告)

HEPATIC INJURY IN PATIENTS WITH EPIDEMIC HEMORRHAGIC FEVER: REPORT OF 35 CASES

报道35例流行性出血热,24例(68.6％)肝功检查单项谷丙转氨酶异常升高,11例(31.4％)谷丙转氮酶无异常。10例肝脏病理检查均能见到不同程度的肝细胞浊肿退变及气球样变;6例有灶性出血,5例有灶性出血性坏死并有炎细胞浸润,血管壁退变及内皮细胞退变坏死4例,出血灶分布部位与血管壁变性坏死相一致;部分可见胆色素沉积,枯否氏细胞增生及脂肪小滴性脂肪变性。肝脏的病理变化与病情轻重相一致。谷丙转氨酶正常者肝组织病理检查仍能见到病理变化,提示流行性出血热绝大部分伴有肝脏病理损害,但这种病理改变与乙型肝炎的肝脏病理变化有明显不同。

In this paper, liver function of 35 patients with epidemic hemorrhagic fever(EHF) was tested and compared with the pathologic examination. Of all the patients, 24(68.6%) had elevated SGPT, 11(31.4%) were normal, pathologic studies confirmed that the hepatocellular degeneration and globular changes in various degree were found in 10 patients, focal hemorrhage in 6 patients, focal necrosis with inflammatory cell infiltration in 5 patients, vascular degeneration and necrosis of endthelial cells in 4 patients. The distribution of hemorrhage is accord with the vascular degeneration. The bile pigment deposited, hyperplasia of Kuptfer' s cells and steatosis were also found in patients partly. The hepatopathological severity was parallel to the seriousness of menifestication. The pathologic changes were also found in patients whose liver functions Were normal. These findings suggests that the hepatopathologcal injuries can be found in most of the patients with EHF, However, these pathological changes are different from those in patients with hepatitis B.