[Disturbance of the cellular immunoreaction at the initial stage of acute infectious hepatitis]

Phytohaemagglutinin-induced lymphocyte transformation and histologic findings in patients with chronic aggressive hepatitis before and during immunosuppressive therapy

In vitro lymphocyte transformation (14C-thymidine incorporation rate following stimulation by PHA) was studied in 19 patients with histologically proven chronic aggressive hepatitis. In the majority of the cases measurements were performed prior to and during a combined (azathioprine/corticosteroid) immunosuppressive therapy. In comparison to normal controls, the majority of the patients showed a significantly reduced lymphocyte transformation before the treatment started. During the immunosuppressive therapy there was a normalization of PHA-responsiveness in most of the patients, or an improvement, at least. Bioptic control seems to be the most reliable parameter to prove a therapeutic effect, since the histologic criteria for a decrease of the inflammatory activity were the last to occur. After transient cessation of the therapy, in 4 out of 6 cases a decrease of lymphocytic PHA-responsiveness was developed again, paralleled by histologic activation of the process where biopsy could be performed. This observation favours a long-term therapy for at least several years.

Antibody titre changes and skin reactivity in patients with liver cirrhosis undergoing portocaval shunt operation

Ten patients with liver cirrhosis undergoing portocaval shunt operation have been followed immunologically during their postoperative course regarding antibody titres to various antigens, viral as well as bacterial. The antibody determinations included rubella, vaccinia and cytomagalo viruses, diptheria toxoid, Candida albicans, streptolysin O, typhoid and paratyphoid O and H and the syphilis reactions: Kahn, Wassermann and Meinicke. Twenty-one blood donors served as controls. Skin test reactions to diptheria, Candida albicans, streptokinase and tuberculin were performed on the same patients. Eight patients submitted to cholecystectomy served as controls for pre-and postoperative skin tests and antibody titres. The liver cirrhosis group before operation had a significantly higher number of elevated antibody titres concomitant with a significantly reduced skin test reactivity to diphtheria toxoid and streptokinase. An increase in the number of elevated antibody titres was seen after portocaval shunt operation. In no case was a higher antibody titre associated with an increase in skin reactivity to the corresponding antigen. A number of significant titre changes to viral antigens were seen in the postoperative course without clinical evidence of the corresponding viral disease. Thes findings indicate that under certain circumstances antibody titre changes should be interpreted with caution.