Histopathological features of chronic hepatitis B reactivation

It was aimed to investigate histopathological changes in acute hepatic exacerbations. A total of 20 patients, who developed acute hepatic exacerbation on the base of chronic hepatitis B infection, were enrolled in the study and liver biopsy was performed. Histological activity index (HAI) and its components, fibrosis scores and total HAI score were calculated according to the Ishak scoring system. All of the patients enrolled in the study had portal inflammation and spotty necrosis. Fibrosis was present in 17 patients. The median grade, stage and total HAI scores of the patients were 7 (2-14), 2 (0-3) and 8.5 (4-16), respectively. Positive correlation was determined between necroinflammation and ALT. While grade and total HAI score did not show significant difference among genders, fibrosis was significantly higher in males (p=0.008). The findings of this study showed that there are significant correlation between histopathologic changes (grade and total HAI score) in liver biopsy and plasma ALT, AST and Total bilirubin levels during acute hepatic exacerbation in patients with chronic hepatitis B infection.

___

1. Chang ML, Liaw YF. Hepatitis B flares in chronic hepatitis B: Pathogenesis, natural course, and management. J Hepatol. 2014;6:1407–17.

2. Feldman M, Friedman LS, Brandt LJ. Acute flares in chronic hepatitis B. Sleisenger and Fordtran’s gastrointestinal and liver disease - pathophysiology, diagnosis, management, 9th edition volume (2). Saunders Elsevier. 2010;1297-8.

3. Yalcın K, Degertekin H, Bahcecioglu IH et al. Hepatitis B virus genotype D prevails in patients with persistently elevated or normal ALT levels in Turkey. Infection. 2004;32:24-9.

4. Liaw YF. Hepatitis flares and hepatitis B e antigen seroconversion: Implication in anti-hepatitis B virus therapy. J Gastroenterol Hepatol. 2003;18:246–52.

5. Mori S, Fujiyama S. Hepatitis B virus reactivation associated with antirheumatic therapy: Risk and prophylaxis recommendations. World J Gastroenterol. 2015;21:10274-89.

6. Mani H, Kleiner DE. Liver biopsy findings in chronic Hepatitis B. Hepatol. 2009;49:61-71.

7. Ott JJ, Stevens GA, Groeger J, et al. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30:2212–9.

8. Lok AS, Bonis P. Hepatitis B virus reactivation associated with immunosuppression. http://.uptodate.com Last literature review version 19.05.2011.

9. Singhal A, Kanagala R, Jalil S et al. Chronic HBV with pregnancy: Reactivation flare causing fulminant hepatic failure. Ann Hepatol. 2011;10: 233-6.

10. Huang YH, Lin HC, Lee SD. Management of chemotherapy-induced hepatitis B virus reactivation. J Chin Med Assoc. 2012;75:359-62.

11. Shouval D, Shibolet O. Immunosuppression and HBV reactivation. Semin Liver Dis. 2013;33:167–77.

12. Liaw YF, Chu CM. Hepatitis B virus infection. Lancet. 2009;373:582–92.

13. Liaw YF, Chu CM, Su IJ, et al. Clinical and histological events preceding hepatitis B e antigen seroconversion in chronic type B hepatitis. Gastroenterol. 1983;84:216–9.

14. Lok AS, Lai CL. Acute exacerbations in Chinese patients with chronic hepatitis B virus (HBV) infection. Incidence, predisposing factors and etiology. J Hepatol. 1990;10:29–34.

15. Liaw YF, Yang SS, Chen TJ, et al. Acute exacerbation in hepatitis B e antigenpositive chronic type B hepatitis: a clinicopathological study. J Hepatol. 1985;1:227–33.

16. Liaw YF, Tai DI, Chu CM, et al. Acute exacerbation in chronic type B hepatitis: comparison between HBeAg and antibody positive patients. Hepatol. 1987;7:20– 3.

17. Hsu YS, Chien RN, Yeh CT, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology. 2002;35:1522–7.

18. Bonino F, Brunetto MR. Chronic hepatitis B e antigen (HBeAg) negative, antiHBe positive hepatitis B: an overview. J Hepatol. 2003;39:160–3.

19. Goodman ZD, Ishak KG. Hepatic histopathology. In: Schiff ER, Sorrell MF, Maddrey WC. Schiff’s diseases of the Liver: 9th edition. Philadelphia: Lippincott Williams & Wilkins. 2003;69-134.

20. Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatol. 2003;38:1449-57.

21. Desmet VJ. Liver: Non-neoplastic diseases. In: Rosai J eds, Rosai and Ackerman’s Surgical Pathology. 9th edition, Philadelphia: Mosby, Elsevier Inc. 2004;917-91.

22. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696-9.

23. Shafaei S, Amiri SS, Hajiahmadi M, et al. Histological grading and staging of liver and its relation to viral loads in chronic anti-HBe positive hepatitis. Caspian J Intern Med. 2013;4:681-5.

24. Kumar M, Sarin SK, Hissar S, et al. Virologic and histologic features of chronic hepatitis B virus infected asymptomatic patients with persistently normal ALT. Gastroenterol. 2008;134:1376-84.

25. Feld JJ, Ayers M, El-Ashry D, et al. Hepatitis B virus DNA prediction rules for hepatitis B e antigen-negative chronic hepatitis B. Hepatol. 2007;46:1057-70.

26. Papatheodoridis G, Manolakopoulos S, Liaw YF, et al. Follow-up and indications for liver biopsy in HBeAg negative chronic hepatitis B virus infection with persistently normal ALT: a systematic review. J Hepatol. 2012;57:196-02.

27. Tai DI, Lin SM, Sheen IS, et al. Long term outcome of hepatitis B e antigen negative hepatitis B surface antigen carriers in relation to change of alanine aminotransferase levels over time. Hepatol. 2009;49:1859-67.

28. Liaw YF, Tai DI, Chu CM, et al. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatol. 1988;8:493-96.

29. Liaw YF, Tsai SL. Pathogenesis and clinical significance of spontaneous exacerbation and remissions in chronic HBV infection. Viral Hepatol Rev. 1997;3:143–54.

30. Sigal SH, Ala A, Ivanov K, et al. Histopathology and clinical correlates of endstage hepatitis B cirrhosis: a possible mechanism to explain the response to antiviral therapy. Liver Transpl. 2005;11:82-8.

31. Tsang PS, Trinh H, Garcia RT, et al. Significant prevalence of histologic disease in patients with chronic hepatitis B and mildly elevated serum alanine aminotransferase levels. Clin Gastroenterol Hepatol. 2008;6:569-74.

32. Seto WK, Lai CL, Ip PP, et al. A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B. PLoS One. 2012;7:32622.

33. Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137:1-10.

34. Cadranel JF, Lahmek P, Causse X, et al. Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis–results of a nationwide survey. Aliment Pharmacol Ther. 2007;26:565-76.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
Sayıdaki Diğer Makaleler

The investigation of clinical and radiological findings of igG4-related autoimmune pancreatitis

Mustafa KOÇ

Characteristics of the immigrant newborns and analysis of short-term results: An example of Giresun

Muhammet BULUT, Dilek KÜÇÜK ALEMDAR

Pararectal epidermoid cyst: A case report

Jebin JOSEPH, Benjith Paul K., Arun Kumar M., Brijesh SONİ, Shiti BOSE

Comparison of biochemical parameters of prevalent hemoglobinopathies with healthy individuals

Emrah YERLİKAYA, Hasan KARAGEÇİLİ, Mustafa Oğuzhan KAYA

Pseudo-Outbreak of Stenotrophomonas maltophilia Isolated from Kidney Stones and Attributed to Inadequate Sterilization: Investigation of Molecular Typing and Clonal Relationship

Reyhan YİŞ, Selma TOSUN, Emine Deniz BAYRAM, Özlem Gamze GÜLFİDAN, Tansu DEĞİRMENCİ, Bülent GÜNLÜSOY, Barış OTLU, Çiğdem KUZUCU

Evaluation of the psychiatric examination findings of victims decided to have sexual abuse occurred as a result of trial

Ferhan KANDEMİR, Bora BÜKEN, Zehra Zerrin ERKOL, Erkan BÜKEN

A study on the differences in legal practices in child abuse cases with examples from different countries

Murat AKBABA, Emre YULUĞ, Mustafa Uğur ŞAŞTIM, Aysun BARANSEL ISIR

A case with unexplained weight loss the underlying cause is aluminum toxicity

Emir CERME, Selcan SEVEN, Ece VURAL, Selda MERCAN, Işıl BAVUNOĞLU

Evaluation of risk factors of diagnostic failure in fine needle biopsy in pulmonary nodules; conventional computed tomography versus computed tomography flouroscopy

Mehmet KOLU, İsmail Okan YILDIRIM

Smoking behavior and attitudes of patient’s relatives in the pediatric emergency rooms- a multi-center study

Selçuk Yasin YILDIZ, Onur ÖZTÜRK, Muhammet BULUT, Arzu AYRALER, Muhammet Ali ORUÇ, Bahadır YAZICIOĞLU, Mustafa ÜNAL, Gülşah ÖZTÜRK, Mi̇kai̇l ÖZDEMİR