急性ビールス性肝炎の予後に関する研究

主として組織学的観察よりみた

抄録

In 20 selected cases of acute viral hepatitis, which showed typical onset with jaundice, serial biopsies were carried out. The first biopsy was done within the initial 3 months and the second one was done during the next 2 to 36 months. Histologial findings of the first biopay specimens were diveded into 2 types according to the characteristics of the fibrotic tissues surrounding the bile duct and vessels (fibrotic area), especially the number of vessels included within the fibrotic area. This area was supposed to represent the size of the necrotic area of the liver at the initial stage.
The histological criteria of each type was as follows:
Type I: Number of the fibrotec areas including one vein within it was over 60% of the total fibrotic areas of each biopsy specimen, but fibrotic areas including more than three veins were quite rare (less than 5% of the total area). Type III; Over 25% of total fibrotic area included more than three veins within it. Type II; Intermediate characteristics between Types I and III.
The type found on histological study in the first biopsy and the second one were unchanged in 17 cases (85%), indicating that the character of each type do not change greatly during the course of acute hepatitis. Twenty cases of acute viral hepatitis were divided into 8 cases of type I, 9 cases of type II, and 3 cases of type III. Seven out of 8 cases classified as type I showed the normal levels of the various liver function tests within the initial 4 months (normal course). The initially abnormal hepatic tests in one case of type I and 6 out of 9 cases with type II returned to the normal levels in 4 to 12 months (protracted course). Three cases of type II and all cases with type III still showed abnormal levels of the hepatic tests after 12 months and showed histological features of chronic hepatitis (chronic course).
The histological findings such as: focal necrosis, hepatic cell regeneration, acidophilic body, Kupffer's cell mobilization, and increased number of intralobular bile ducts, were most prominent in type III.
The histological features of type II or III were more frequently found in the cases of posttransfusion hepatitis, which showed protracted or chronic course, than in the cases of infectious hepatitis.
These results suggest that the clinical course or prognosis of acute viral hepatitis is strongly affected by the size of destructive area of the liver occurring at the initial stage. Histological classification during the initial stage is very useful in evaluating the prognosis of acute viral hepatitis.