Serological Abnormalities in Patients with Liver Disease

Patients with active cirrhosis of the liver may show evidence of multiple system involvement (Read, Sherlock, and Harrison, 1963).The suggestion has also been made that in such patients autoimmune phenomena play an important part in the patho- genesis of the disease (Mackay, Taft, and Cowling, 1956).These findings prompted us to undertake an investigation into the frequency with which antinuclear factors (A.N.F.) and other autoantibodies occur in the sera of patients with various types of liver disease. Patients Studied and Diagnostic GroupsA total of 116 cases of liver disease were studied, of which 104 were shown to have some form of cirrhosis.Alcoholic Cirrhosis.-Thisgroup comprised 10 patients- seven males and three females.Their ages varied from 30 to 69, with a mean of 50.5 years.All gave a history of excessive alcohol intake and many showed peripheral neuropathy, parotid enlargement, and gynaecomastia.Liver biopsies revealed portal cirrhosis with a variable degree of fatty infiltration: Mallory's hyaline was present in some."7uvenile" Cirrhosis.-Therewere 38 patients-18 males and 20 females-in this group.Their ages varied from 6 to 67, with a mean of 27 years.The term " juvenile " cirrhosis describes a group of patients showing all or most of the follow- ing features: marked hypergammaglobulinaemia, elevated serum transaminase and serum bilirubin levels, and cirrhosis, usually post-necrotic in character (Read et al., 1963).A prominent feature of the liver histology is the plasma-cell and lymphocytic infiltration and the tendency for the liver cells to take up a rosette-like formation.This group resembles those cases described by Bearn, Kunkel, and Slater (1956), and called plasma-cell hepatitis, active chronic hepatitis, and lupoid hepatitis (Mackay and Wood, 1962).Primary Biliary Cirrhosis.-Therewere 12 patients in this group, all females.Their ages ranged from 33 to 59, with a mean of 48 years.Pruritus, intrahepatic cholestasis, and an elevated serum cholesterol were prominent features of the illness (Sherlock, 1959).The majority had undergone a previous laparotomy, when the patency of the biliary tree had been established.Liver histology was characterized by aggressive, infiltrating fibrosis in the portal zones, inconspicuous bile- ductules, and foci of lymphocytes.Virus Hepatitis.-Therewere 12 patients in this group-five males and seven females.Their ages varied from 26 to 61, with a mean of 36 years.All had been admitted in the second or third week of their illness, the majority because of severe cholestasis.This group therefore does not represent the usual type of virus hepatitis. InvestigationsLiver histology, obtained by percutaneous liver biopsy or at operation, was available on all the patients studied except the