[Porphyrin metabolism in chronic liver diseases]

Out of 147 patients with chronic hepatic diseases, chronic persistent hepatitis, chronic active hepatitis, hepatic cirrhosis, alcoholic lesions of the liver, biliary hepatic cirrhosis and Gilbert syndrome were registered in 26, 35, 27, 43, 8 and 8 patients, respectively. Urinary and fecal porphyrins were measured spectrophotometrically. Disturbances in porphyrin metabolism were diagnosed in 76 patients (51.7%). Four different biochemical syndromes were identified: 1) a symptomatic rise of fecal porphyrins only, 2) secondary coproporphyrinuria, 3) secondary coproporphyrinuria in combination with high fecal protoporphyrin, 4) biochemical syndrome of chronic latent hepatic porphyria. These syndromes were not strictly specific, but secondary coproporphyrinuria occurred significantly more often in chronic active hepatitis and biliary cirrhosis. High symptomatic fecal porphyrins were characteristic for alcoholic affections, and latent hepatic porphyria was indicative of hepatic cirrhosis. Disturbed porphyrin metabolism arises in more severe hepatic lesions and runs in association with more rapid development of hepatocellular insufficiency. Probable pathochemical mechanism and diagnostic value of the above impairment are discussed.