Features of chronic hepatitis in alcoholics. A survey in Milan.

A study was carried out to confirm the pathogenetic role of ethanol in the development of chronic active hepatitis (CAH) and to assess if previous or current superimposed hepatitis B virus (HBV) infection could be relevant to the course of alcoholic liver disease (ALD). We examined clinical and laboratory reports of 57 alcoholics with biopsy-proven CAH. Serum and/or tissue HBV markers and the presence or absence of cirrhosis were investigated. Alcohol was the only aetiological factor present in a small group of CAH, with or without histological findings suggestive of alcoholic damage. Age, sex and survival were similar among the subgroups of CAH with and without previous or current HBV infection and among the subgroups of CAH with and without associated histological alcoholic features. Among the laboratory data, the AST/ALT ratio was higher in CAH without previous or current HBV infection. The mean age was comparable in CAH patients with and without cirrhosis, whereas the cumulative 5-year survival was worse in CAH with cirrhosis (87% vs. 49%). These data suggest a difference in alcohol susceptibility in our subjects.

Procollagen-type III peptide serum concentrations in alcoholic and non-alcoholic liver disease.

The type III procollagen aminopeptide (sPIIIP) serum levels were measured in 197 patients with liver disease and were correlated with morphological and serological alterations and with alcohol drinking habits. The sPIIIP levels resulted significantly increased in 51% of 43 patients with untreated chronic active hepatitis (CAH), in 61% of 36 patients with CAH plus cirrhosis, in 69% of 26 patients with inactive cirrhosis, in 4 out of 8 patients with alcoholic steatosis and fibrillogenesis, but remained unchanged in 38 cases of alcoholic steatosis plus siderosis and in 13 cases of chronic persistent hepatitis. A correlation between sPIIIP levels and the histological pattern of fibrosis could not be demonstrated in a single type of fibrotic liver disease and no differences were found between alcoholic and non-alcoholic patients. We agree upon the opinion that high sPIIIP levels may identify liver fibrogenic activity, but this test needs further technical improvements before it could be widely used in the clinical practice.

Significance of circulating C1q-binding activity in chronic liver disease: a study of 133 cases.

Circulating immune complexes (CIC) were measured in 133 biopsy-proven patients with various liver diseases. The correlation between CIC levels and other laboratory findings was investigated in each disease group, in order to assess if the increased C1q-binding activity found in these patients was related to particular features of the disease. CIC levels were not significantly different in HBsAg-positive and HBsAg-negative patients. No correlation was found between CIC levels and serum bilirubin, AST, ALT and C3 levels. A negative correlation with C4 levels and a positive correlation with immunoglobulin levels were found in the majority of the patients, while prothrombin time and albumin levels were negatively correlated to CIC levels only in patients with chronic active hepatitis. Increased CIC levels could represent a response to gut-associated antigens, a passive accumulation due to reduced hepatic function or both.

[Prevalence of antibodies against the hepatitis B virus in alcoholic liver diseases]. / Prevalenza degli anticorpi contro il virus dell'epatite B nelle epatopatie alcoliche.

The prevalence of serum antibody to hepatitis B virus antigen (anti-HBs and anti-HBc) were determined in biopsy proven alcoholic liver disease (n = 60), compared with: an age and sex-matched hospital control population (n = 60), HBsAg-negative chronic liver disease (n = 27), renal unit patients (n = 32) and volunteer blood donors (n = 286). All sera were HBsAg negative (RIA). The prevalence of total hepatitis B virus antibody was significantly increased (p less than 0,001) in alcoholic liver disease (71%), as well as in renal unit patients (65%) and non-alcoholic liver disease (66%), versus hospital controls (35%) and blood donors (43%). These data suggest that hepatitis B virus infection might be a factor in selecting which alcoholic patients go to develop hepatic damage.

Correlation between helper/suppressor ratio and IgA levels in the peripheral blood from patients with liver diseases.

The correlation between serum immunoglobulin levels and "helper/suppressor" (T4/T8) ratio has been investigated in 45 patients with biopsy proven liver diseases (22 with ALD, 16 with CAH and 7 with VHR). In the ALD and CAH groups the T4/T8 ratio was significantly higher than in normal controls and a strong correlation was noticed with IgA, but not IgG and IgM levels. The same correlation was found in the VHR group as well, even if the mean value for the T4/T8 ratio in these patients was not significantly above that of normal controls. The pathogenetic significance of these findings is discussed.

[Erythrocyte indices in smokers and heroin addicts]. / Indici eritrocitari in fumatori ed eroinomani.

Red blood cells values of 100 male heroin addicts, 100 male smokers and 100 normal men, all of like age, have been examined. Nearly all of the heroin addicts are heavy cigarette smokers. The GRC/mm3, Hb g%, Ht%, MCHC and MCV values did not show significant statistical differences between the three groups, except the MCV in the average appeared 2,8 mu3 higher in the smokers, than the normal non smokers. In heroin addicts there did not appear any variation related to abnormalities in liver function and dependency life time. The differences between the results of our studies and the literature are determined from a longer exposition to the damage caused from heroin and smoke.

[HBsAg frequency in asymptomatic heroin users living in Milan (author's transl)]. / Incidenza dell'antigene HBs in eroinomani asintomatici della citta' di Milano.

185 asymptomatic heroin addicts in whom the incidence of positivity as for HBsAg was 9.1%, were examined. From the anamnesis, these carriers has a higher frequency of icteric events in comparison with patient controls, while they did not show differences in distribution according to age, duration of the toxicomania and regional origin of the family. 38 heroin addicts were alcoholics too: 6/38 were HBs carriers, whereas 11/147 non alcoholic were carriers. The group of HBsAg positive addicts showed an analogous alteration of the transaminase levels as regards the patient controls, while the incidence of hypoalbuminemia and hypergammaglobulinemia was higher. In consideration of these results, the possible responsibility of toxic factors (alcohol) and alterations of the immune reactivity as to the prolonged permanence of HBsAg in circle is discussed.