Theresa Propst, MD; Albert Propst, MD; Otto Dietze, MD; Gert Judmaier, MD; Herbert Braunsteiner, MD; Wolfgang Vogel, MD
▪ Objective: To determine the prevalence of chronic liver disease in adults with homozygous (Pi ZZ) and heterozygous (Pi Z) α1-antitrypsin deficiency and to assess the presence of other possible risk factors for the development of chronic active hepatitis and cirrhosis of the liver in these patients.
▪ Design: Cross-sectional study.
▪ Setting: A referral-based university hospital.
▪ Patients: Consecutive patients (164) with the Pi ZZ and Pi Z phenotype with and without chronic liver disease.
▪ Measurements: The presence of antibody to hepatitis C virus (anti-HCV) was determined using an assay incorporating synthetic peptide antigen from capsid protein (United Biomedical [UBI] assay) and a second-generation enzyme immunoassay (Abbott test); the presence of antibody to hepatitis B virus (anti-HBV) was determined using radioimmunoassays incorporating hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg); assays for antinuclear antibody and antimitochondrial antibody (M2 subtype) were also done, and alcohol abuse was assessed by history.
▪ Results: Among patients with cirrhosis (32%), 62% were anti-HCV positive by the Abbott test (P = 0.006), and 41% were anti-HCV positive by the UBI assay (P = 0.007). Thirty-three percent of patients with cirrhosis had hepatitis B virus (HBV) infection (P = 0.01); 41% had a history of alcoholism; and 12% had features of autoimmune liver disease. Only five patients (9%) with cirrhosis had no other risk factor for chronic liver disease. Among patients with chronic active hepatitis (7%), 80% were anti-HCV positive by the Abbott test (P = 0.002), and 75% were anti-HCV positive by the UBI assay (P < 0.001). Thirty percent of patients with chronic active hepatitis had HBV infection (P = 0.023); 18% had autoimmune hepatitis; and 8% abused alcohol. Only two patients (17%) had no additional risk factor for the development of chronic active hepatitis. Among patients with steatosis of the liver (48%), 5% were anti-HCV positive by the Abbott test, and none were anti-HCV positive by the UBI assay; 18% had serologic evidence of past HBV infection, and 28% abused alcohol. Among patients without chronic liver disease (13%), no viral infection could be found; 9% were alcoholics.
▪ Conclusions: Chronic liver disease in patients with α1-antitrypsin deficiency is associated with a high prevalence of viral infection; this infection, rather than α1-antitrypsin deficiency alone, may be the cause of the liver disease in such patients.
Propst T, Propst A, Dietze O, Judmaier G, Braunsteiner H, Vogel W. High Prevalence of Viral Infection in Adults with Homozygous and Heterozygous Alpha1-Antitrypsin Deficiency and Chronic Liver Disease. Ann Intern Med. ;117:641–645. doi: 10.7326/0003-4819-117-8-641
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Published: Ann Intern Med. 1992;117(8):641-645.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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