纤维性胆汁淤积性肝炎是致肝病毒感染过程中的一种变体

V. Syutkin, V. Chulanov
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摘要

纤维化性胆汁淤积性肝炎(FCH)是传染性肝炎病史的一种特殊变异,肝功能迅速进行性恶化;通常在免疫抑制情况下发病;也有报道称免疫功能正常的乙型和丙型病毒性肝炎患者也会发生 FCH。FCH 的诊断依据是肝组织的组织学检查,检查结果显示肝细胞主要受损,在微弱的炎症反应、细胞周围和窦周纤维化以及细胞内和肾小管胆汁淤积的基础上,肝细胞明显膨胀。文献分析证实了作者的假设,即在各种感染病原体的影响下,肝脏会在不同条件下发生病理变化,即 FCH。尽管对乙型肝炎和丙型肝炎有有效的抗病毒疗法,但 FCH 的治疗结果往往并不理想,尤其是与实体器官移植无关的病例。目前,由于出现了大量选择性作用于免疫系统的药物,以及血液学、风湿病学、肿瘤学、移植学和传染病学等新医学领域的发展,这些专业的医生在接受特定治疗时越来越多地面临意想不到的严重肝损伤。作者认为,不在肝移植中心工作的医生低估了乙型和丙型病毒性肝炎患者发生 FCH 的可能性,无论是在传染病诊所还是在内科疾病诊所都是如此。
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Fibrosing cholestatic hepatitis as a variant of the course of hepatotropic viruses’ infection
Fibrosing cholestatic hepatitis (FCH) is a special variant of the history of infectious hepatitis, with a rapid progressive deterioration of liver function; usually develops in immunosuppression; it has also been reported in immunocompetent patients with viral hepatitis B and C. The diagnosis of FCH is based on histological examination of liver tissue, which reveals the predominance of damage to hepatocytes with their pronounced ballooning over a weak inflammatory reaction, pericellular and perisinusoidal fibrosis, and also intracellular and tubular cholestasis. Analysis of the literature confirms the authors' assumption that pathological changes in the liver, described as FCH, can develop in different conditions under the influence of various infectious agents. Despite the availability of effective antiviral therapy for hepatitis B and C, the outcomes of FCH are often unfavorable, especially in cases not associated with solid organ transplantation. Currently, due to the emergence of a large number of drugs that selectively act on the immune system, the development of new areas of medicine in hematology, rheumatology, oncology, transplantology, and infectious diseases, doctors in these specialties are increasingly faced with unexpectedly severe forms of liver damage on specific therapy. The authors believe that there is an underestimation by doctors who do not work at Liver Transplantation Centers of the possibility of developing FCH in patients with viral hepatitis B and C, both in the clinic of infectious and internal diseases.
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