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Persistent immune deficiency in patients with alcoholic hepatitis
M G Mutchnick1, I A Cohen, G H Elta
1Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan.
The American Journal of Gastroenterology
|April 1, 1990
Summary
Severe alcoholic hepatitis (AH) impairs cell-mediated immunity, causing persistent T-lymphocyte subset abnormalities and reduced skin test responses. These immune dysfunctions continue for weeks even after alcohol cessation.
Area of Science:
- Immunology
- Hepatology
- Cellular Biology
Background:
- Severe alcoholic hepatitis (AH) is associated with immune system dysfunction.
- Understanding the specific immunological deficits in AH is crucial for patient management.
Purpose of the Study:
- To investigate serial changes in T-lymphocyte subsets, skin test responses, and lymphocyte proliferation in patients with severe AH.
- To determine the persistence of these immune abnormalities after alcohol withdrawal.
Main Methods:
- Evaluated 12 patients with severe AH through serial blood tests and skin antigen testing.
- Assessed T-lymphocyte subsets (T4, T8), recall-antigen skin test responses (Candida, mumps), and mitogen-induced lymphocyte proliferation (concanavalin A, phytohemagglutinin).
Main Results:
- Patients with AH exhibited decreased peripheral blood lymphocyte counts and T-cell subsets, notably T8 cells, leading to increased T4:T8 ratios.
- Significantly diminished skin test responses to Candida and mumps antigens were observed, with 58% of patients showing anergy.
- Increased concanavalin A-induced lymphocyte proliferation, but not phytohemagglutinin-induced proliferation, was noted.
Conclusions:
- Severe alcoholic hepatitis causes persistent cell-mediated immune dysfunction, including altered T-lymphocyte subsets and impaired skin test reactivity.
- These immunological abnormalities persist for at least six weeks following alcohol cessation.