Studies on patients with cirrhosis of the liver: Plasma and liver lipid distribution and its relation to the pathology of the liver

The plasma and liver lipids were determined in twenty-one subjects, nineteen of whom had cirrhosis of the liver. All of the subjects were adults and nine were females. Of the nineteen patients with cirrhosis, sixteen had ascites and fifteen were jaundiced. The liver samples were obtained at postmortem. The time interval between the blood and liver samples varied from twentyfour hours to 254 days. The values for the various lipid fractions over these periods of time were altered significantly in only one case. None of the patients improved clinically to any significant extent during the period of observation. The most consistent and outstanding change in the plasmas in all of the patients with cirrhosis of the liver was the alteration of the ratio of free to total cholesterol which was inverted in every instance. Plasma lipids were elevated in seven cases, and in three patients this was associated with a marked increase in the liver lipids. In a total of five cases liver lipids were greatly increased. In twelve patients the only significant change in lipid distribution in the plasma was in the ratio of free to total cholesterol. The per cent water was determined in the livers of six patients. When lipid fractions were calculated on the basis of the dry weight of the liver, their relation to each other was unchanged. Partition of the phospholipids was done in four of the livers, and the relative concentrations of lecithin, cephalin and sphingomyelin in three of these cases were very similar to those reported by Thannhauser and showed an average percentile distribution of phospholipids of 63.3, 31.6 and 5.0 per cent, respectively. Vitamin A and carotene levels were determined in the plasmas and livers of eleven of the cases. Vitamin A levels in plasma were uniformly low and carotene was also below normal levels in most of the cases. In all but two of the livers the vitamin A and carotene levels were below normal values.