[Vascular purpura in patients with chronic diffuse hepatic diseases]

The purpose of the study was to evaluate clinical significance of vascular purpura (VP) in diagnostics and establishing prognosis of chronic diffuse hepatic diseases (CDHD). The subjects were 660 patients with CDHD of viral and non-viral origin, who were under long hospital observation. 72 CDHD patients had cutaneous vasculitis. 11% of CDHD patients developed VP, which corresponded to the frequency of other cutaneous manifestations--minor hepatic signs (palmar erythema, spider-like blood vessels in the skin, xanthelasmas etc.) There was insignificant difference in the frequency of VP between the patients with type B and C hepatitis (9.6%), on the one part, and patients with non-viral hepatic diseases--primary sclerosing cholangitis, autoimmune hepatitis, and Wilson-Konovalov disease (14.2%). According to morphological data, 84.3% of CDHD patients with VP developed the latter or had a VP relapse at the cirrhotic stage (50%) or at the stage of forming hepatic cirrhosis (34.3%). Renal involvement, which was significantly more frequent in CDHD patients with VP vs. patients without VP (32% and 11.4%, respectively), may deteriorate the prognosis. The authors conclude that cutaneous vasculitits is a universal sign of viral and non-viral CDHD, which should be taken into consideration when diagnosing and establishing prognosis of these diseases. The fact that VP is revealed mainly at the cirrhotic stage suggests that an important role in its development is played by dysfunction of the liver, one of the main organs that clear antigen and immune complexes (including those of viral origin), appearing via the portal system or circulating in blood.