The serum phospholipids (separation by thin layer chromatography) were studied in 22 children with infectious hepatitis; a characteristic change was observed during the acute stage:
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The level of total serum phospholipids was significantly increased to an average of 167.8 ~g/ml (SD 4-22.3 ,ug/ml) compared to a control group of 20 healthy children who had a mean concentration of 69.4 ~xg/ml (SD ~ 10.5 ~g/ml; P < 0.001). Like the other parameters described here the values for total phospholipids returned to normal levels within 20 days from the beginning of treatment (68.7 izg/ml; SD :~ 14.1 ixg/ml).
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The most obvious change among the phospholipid fractions was a significant rise in lecithine. In acute hepatitis serum the lecithine fraction amounted to a mean value of 126.3 ~g/ml (SD ~: 20.0 ~g/ml) i.e. 73O/o of the total phospholipids.
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The absolute values for sphingomyeline and lysolecthine were higher than normal; however, the relative values for these two fractions were shown to be lower than normal.
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Therefore it seems to be serum leeithine which is responsible for the behaviour of the total phospholipids. In contrast to other investigators we found in our patients that the smallest deviations from normal values were observed in cephaline and lysolecithine. Although tysolecithine is considered a sensitive indicator for disturbances of the liver parenchyma it seemed to be affected to a lesser degree by hepatitis than the lecithine fraction.
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In agreement with other biochemical and clinical findings the abnormalities in the ratio of the various phospholipids could no longer be demonstrated when serum samples were examined after 20 days of treatment.
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To a large extent the changes in serum phospholipids seem to be the result of a defective membrane function in the liver cell during acute hepatitis. Thus an increased release of leeithine and other phospholipids into the extraeellular space may occur. Since obstructive jaundice is usually accompanied by high serum concentrations of tecithine and free cholesterol the possibility exists that a transitory bile retention plays a certain part in acute hepatitis.