慢性肝炎の病態に関する臨床的研究 : 特に遷延化,慢性化に関して
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概要
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Most cases of acute viral hepatitis recover completely in short period while some of them are prolonged in their healing process and can develop into chronic form. We have studied the results of observation on long term clinical course of viral hepatitis on the basis of the biochemical and histological investigations. In most cases of acute viral hepatitis, SGOT activity usually decrease from the peak at the onset into normal lebel in 4 to 6 weeks. Serum colloidal reaction (especially T.T.T. and Z.S.T.) are also negative at the onset. But as it's recovery are prolonged, their titers gradually increase and become pasitive. On the other hand, there are patients with serum colloidal reactions being positive at their onsets. Most of these patients have history and predisposing condition of pathological process which produce hepatic injury ; and their SGOT activities frequently elevated again after 4 to 6 weeks and remain abnormally high. In cholestatic form of viral hepatitis, serum bilirubin and alkaline phosphatase activity increases from the onset and delays in return to normal level. Serum colloidal reactions are generally negative even in the advanced stage, as in group of hepatosis. In former group, serum bilirubin and alkaline phosphatase activity tends to remain high when SGOT liberation from liver cell is more extreme. This suggests that these reactions are probably representing exsistence of pathological lesions in bile capillaries. We have studied the duration until histological diagnosis was established by taking biopsies in certain intervals. These findings in relation to periodical histological results are also investigated. Histologically, subchronic and chronic stages were found in practically at any period from 3 months to 2 years after the onset. It is important that at 3 or 4 months after the onset of acute viral hepatitis, some already showed histological findings of chronic active form. This shows that viral hepatitis can be developed rapidly into fluminating form of chronic hepatitis in relatively short period. In these stages of viral hepatitis, we have analysed liver function test patterns as compared with histological findings. In most cases of acute viral hepatitis, SGOT activity which is high at the onset usually decrease into normal level in 4 to 6 weeks. In some cases SGOT activity once decrease from the peak and remain abnormally high and tended to persist for 3 months or longer. In these cases we found that titers of serum colloidal reactions or serum alkaline phosphatase activity were mostly abnormally in high level at the onset. Some of these cases show high SGOT level of more than 100 Karmen units persistently for longer than 3 months, and were found rather frequently in subchronic or chronic form. The cases, serum colloidal reactions being positive at the onset, become high again abnormally higher and abnormal findings were observed in the liver mesenchym, such as proliferation of Kupffer cells in earlier stages. But, we also observed the cases that when serum colloidal reaction show constant positive findings, then persistent increase of SGOT value that have been observed in other instances, show decrease even to the value of normal limit. During 3 months after the onset, SGOT activity has persisted above 100 Karmen units and serum colloidal reactions were constantly positive. These types of liver function test pattern were usually show biochemical findings of chronic active hepatitis. We consider that persistent, SGOT activity (above 100 Karmen units) losting longer than 4 weeks is a characteristic of protracted hepatitis or development into chronic changes in early stages of viral hepatitis. But, this was observed in cases both serum colloidal reactions positive or negative at the onset. Furthermore, abnormal findings of liver mesenchym, such as proliferation of Kupffer cells were found even in the patients with normal serum colloidal reactions of such abnormal SGOT activity persisted for longer than 3 months from the onset. This type is representing so-called "persistent type of viral hepatitis". From our results, we have concluded that abnormal findings of liver mesenchym plays an important role in the prolongation of viral hepatitis recovery and development into chronic hepatitis. This fact can be directly triggered by repeated necrotic changes of hepatic cells. When a mesenchymal inflammatory process is present, persistent increase of SGOT value is inhibited and a decrease even to the normal limit may be seen. Under this circumstances, cholestasis can hardly occur.
- 千葉大学の論文