輸血後肝炎の臨床病理学的研究

第1編 診断基準の設定

抄録

It requires a serious consideration on the recent increase in the number of cases of posttransfusion hepatitis. In contrast to infectious hepatitis, the majority of the cases with this condition tends to show a prolonged chronic course and develop into liver cirrhosis and for such a condition early hospitalization and exhaustive treatment are urgent.
At the present stage where have as yet to discover hepatitis virus, diagnosis for posttransfusion hepatitis is generally established on the over-all findings collected from the conditions of transfused blood and plasma, subjective and objective symptoms, findings of liver function tests, and peritoneoscopic findings combined with the histopathological studies by liver biopsy, but the diagnosis based on the histological findings seems to be the most reliable one. For the purpose to make a diagnosis accurately as ealy as possible, the author has established a criteria for the diagnosis in terms of liver function tests by comparing the function with the histological findings.
The sujects of the present study were consisted of 244 cases of those who underwent surgical operation and received blood transfusion, and 46 cases who received surgical operation but no transfusion during the period from September, 1964 to January, 1965 at the Okayama University Hospital and the Yuwakuni National Hospital, and these cases were followed up peiodically for their liver function. The histopathological examinations with liver biopsy specimens revealed that 3 cases proved to be normal, 8 cases with hepatosis, 32 cases with acute viral hepatitis. By studying GPT and BSP (45') values in each group of these conditions and by determining the threshold values of those having acute viral hepatitis, the following criteria in terms of liver function tests has been established for the diagnosis.
I. In the cases beyond the 30th day after blood transfusion
1. GPT proves to be over 150 units;
2. In the cases whose GPT is between 149 and 90 units,
(i) there are those whose GPT activity persist over two weeks, or
(ii) those whose BSP (45') value is over 10%
3. In those who maintain GPT value between 89 and 60 units more than two weeks and BSP over 10%;
II. For those showing disturbances of the liver function prior to the 30th day after transfusion and with GPT of less than 60 units, namely, those suspicious cases who do not satisfy the criteria, follow-up observations are to be continued and biopsy of liver is recommended.
Misdiagnosis occurring in the dagnosis by the criteria proved to be 5/52 cases, and four of tham were the cases of diabetics. Other examinations of liver function failed to help early diagnosis of this conition.