유행성 Virus간염의 임상상과 간침생검 조직상에 관한 연구 제3편 급성 Virus간염의 후유증 및 합병증에 관한 연구

Abstract

The complications and sequelae of viral hepatitis were studied in 143 acute cases and 15 chronic cases. utilizing a correlation of the clinical picture with laboratory findings and serial liver biopsies. Of the 143 acute cases studied. 98 cases underwent serial biopsies. 45 cases had a single biopsy. Of the 98 cases studied by serial biopsies: 19 cases had histologic findings consistent with cholangiolitic change. 79 cases had histologic findings of hepatocellular damage. 15 cases of chronic hepatitis were studied by single biopsy. The following results were observed. 1. In 43.6% of these patients with acute viral hepatitis. there was no histologic clearance within 3 months after the onset of illness. Differently from acute phase, this prolonged histological findings were mainly fibrosis. mononuclear cell infiltration. and cholangiolitic change around the portal areas. There were rarely noted fatty metamorphosis. 2. Of the 87 cases of acute ·hepatitis. 10 cases (11.4%) showed evidence of recurrent or relapsing phases of the disease. The histologic picture of the latent stage which followed the initial attacn: was mainly that of arrested cholangiolitic involvement with no evidence of healing. Only in one case. there was histologic evidence of reactivation during a relapsing stage_ Of the 10 cases. 2 cases showed complete healing. 1 case progressed into a chronic hepatitis with portal cirrhosis. 7 cases had a persistence of the cholangiolitic changes in final outcome. 3. Of the 98 cases studied 1:>y serial biopsies. in 19 cases significant histologic pattern Was that of cholangiolitic damage. Comparing with hepatocelular hepatitis, clinically nausea, vomiting, itching sensation and hepatomeg.dy were remarkable; in laboratory findings a slight leukocytosis, positive urine bilirubin, increased direct reactive serum bilirubin and abnormal retention of BSP were more striking; histologically bile stasis, bile duct proliferation and inflammatory cellular infiltration (especially neutrophils) were remarkable in the patients of cholangiolitic damage. of this group, 11 cases showed persistent cholangiolar involvement and 3 of these 11 cases progressed to cirrhosis_ 4. Viral hepatitis combine with liver distosomiasis and cholecystitis showed every characteristic clinical, laboratory and histologic findings of cho langiolitic type_ 5. Of these 98 cases studied by serial biopsies, 79 cases were characterized by hepatocellular changes Of this group, 18 cases showed marked portal fibrosis and 4- of these 18 cases progressed to portal cirrhosis. 6. The cases of chronic hepatitis studied were 15 cases. 6 of these had mild splenomegaly, 4 of these had slight hepatomegaly, 6 of these had persistent jaundice. All of these cases had active viral hepatitis persisting for more than one year as proven by needle biopsy.