Autoimmune tests in chronic active disease of the liver

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CHRONIC disease of the liver may be defined as any progressive hepatic disease of longer than three months’ duration. This definition excludes most cases of acute viral or toxic hepatitis, however there may be indicators of continuing chemical or histologic activity, such as elevation of serum transaminase or active cellular necrosis in the liver biopsy specimen. Chronic disease of the liver is a heterogeneous group of diseases with a wide range of clinical and pathologic features that tend to progress toward terminal hepatic disease with its resultant portal hypertension, ascites, and coma.

Study of the immunologic aspects of chronic disease of the liver may add to our understanding of etiology and pathogenesis, and help to evaluate better the methods of treatment. Two observations have stimulated interest in the immunologic aspects of chronic hepatic disease: (1) the presence of elevated serum γ-globulins (immunoglobulins), and (2) detection of serum autoanti-bodies. Sincc Kunkel and associates1 found evidence of lupus erythematosus (hypergammaglobulinemia and L.E. cells) in young females with chronic liver disease, a number of circulating autoantibodies have been discovered.2 By employing immunofluorescent technics, autoantibodies to mitochondria (AMA),3–5 smooth muscle (SMA),6, 7 and cell nuclei, antinuclear factor (ANF),3, 5 have been found. Antibodies to renal glomeruli,8 biliary canaliculi,9 thyroid cell,3 and gastric parietal cell3 also have been found, but not so frequently as those in the former group. Only AMA, SMA, ANF, and L.E. tests have had wide clinical application in chronic disease of the liver.

At the Cleveland Clinic these autoantibodies and quantitative . . .



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