울혈성 간 손상의 임상상과 조직학적 소견

To assess the clinical, biochemical and morphological findings in regard to the severity and duration of hepatic venous outflow block we reviewed 22 patients including 6 patients with acute and chronic heart failure (Group I ), 5 patients with constrictive pericarditis (Group II), and 12 patients with Budd-Chiari syndrome (Group lII). Suggestive causes of heart failures were Graves disease, right atrial myxoma, bacterial endocarditis, acute and chronic renal fai]ures and atrial fibrillation. Most of the constrictive pericarditis seenied to be developed by tuberculosis and all of the Budd-Chinri syndrome were suggested to be induced by segrnental obstruction of inferior vena cava at the level of diaphragm with regard to clinical, laboratory, and radiologica] findings. The clinical findings in most of the cases of group I resembled acute viral hepatitis and the cases of latter two groups revealed chronic liver disease. The serum AST,'ALT (:>15+640 unit/321+371 unit) and TB (3. 3+ 3. 6 mg/dl) of group 1 were elevated significantly compared to those (38+ 23 unit,' 20+10, unit, 1.6+1.1 mgi'dl) of group III (p< 0.0;>). The liver cirrhosis with regenerative nodules v, as more cornmonly seen in the cases with Budd- Chiari syndrome (90.99.) than in patients with constrictive pericarditis (20r,), while no hepatic cirrhosis was observed in cases with congestive heart failure. In hepatic congestion, great variations of histological changes throughout the liver partly explain the poor correlation between the structural changes and clinical and Jaboratory findings on the one hand, and between the degree and duration of the cardiac failure and the regin of the venous out-block on the other.