Revista da Sociedade Brasileira de Medicina Tropical (Dec 1993)
O vírus da hepatite B na doença hepática alcoólica: avaliação clínica e bioquímica
Abstract
Foram estudados prospectiva e seqüencialmente 107 pacientes com doença hepática alcoólica (DHA) crônica, sendo 83 casos de cirrose e 24de hepatite alcoólica. Além do etilismo, ingestão mínima de 70 gramas de etanol puro ao dia por período superior a sete anos, todos apresentaram disfunção hepatocelular. De acordo com o perfil sorológico para o VHB os pacientes foram alocados em quatro grupos a saber: grupo I infectados: AgHBs e anti-HBc positivos; grupo II imunes: anti-HBs e anti-HBc positivos; grupo III sem marcadores do VHB: AgHBs, anti-HBc e anti-HBs negativos; grupo IV anti-HBc positivo isoladamente. A prevalência de infecção pelo VHB na DHA foi alta: 42,06% apesar dos índices pouco elevados de imunidade: 26,17% sugerindo que na DHA ocorre maior exposição ao VHB com resposta imunológica deficiente. A análise dos parâmetros clínico-bioquímicos, quando considerados isoladamente, não mostrou diferenças estatisticamente significantes entre os grupos I, II, e III, entretanto a classificação de Child/Campbell, discriminou o grupo infectado, onde houve predomínio da classe C, de pior prognóstico.The aim of our work was to study the prevalence of HBV markers in Alcoholic Liver Disease (ALD) by evaluating clinical and biochemical parameters that couldfurther characterize the association. A prospective and sequential study of 107 patients with ALD was performed, including 83 cases of cirrhosis and 24 cases of alcoholic hepatitis. Daily ingestionofpure ethanolwas of at least 70gm for seven years or more and always associated with hepatocelullar disfunction. According to the serological profilefor HBVmarkers the patients were allocated to one of four groups: group I infected (positivity ofHBsAg and anti-HBc); group II immunized (positivity of anti-HBs and anti-HBc); group 111 without HBV markers (negativity of HBsAg, anti-HBc and anti- HBs); group IV isolated anti-HBc. The prevalence of HBsAg positivity in ALD was high: 15.89% whereas immunity was low: 26.17% suggesting a great exposure to the virus and a deficient immunological response. No significant statistical differences were found among the three groups when clinical and biochemicalparameters were individually considered. Nevertheless, when a Chitd/Campbell classification was applied, patients with ALD associated with HBV (group 1) showed a significant difference, presenting a predominance of child C, with a bad prognosis.
