Biliary lipids, faecal steroids, and serum bile acids were studied in patients with chronic active hepatitis and primary biliary cirrhosis. The results were correlated with excretory and parenchymal liver function tests and with the presence or absence of orcein-positive copper-protein complexes in histological liver specimens. In general, faecal bile acids, but not neutral and total sterols, correlated negatively with the percentage of biliary cholic acid, serum cholesterol, and serum bile acids and positively with the percentage of biliary deoxycholic acid. In orcein-positive subjects-indicative of long-standing cholestasis-the bile was undersaturated with cholesterol, biliary deoxycholic acid was subnormal, cholic acid correspondingly increased, and serum cholesterol and bile acids were raised. Only patients with marked impairment of both excretory and parenchymal liver functions had a decreased output of neutral sterols, bile acids, and total steroids, and, thus, low bile acid and cholesterol synthesis. The findings indicate that mild disturbances in parenchymal liver function infrequently cause major changes in cholesterol metabolism, while abnormalities in secretory liver function-in orcein-positive subjects especially-are frequently associated with proportionate changes in parameters of cholesterol metabolism.
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