Correlation Of Histopathological, Biochemical & Clinical Spectrum Of Chronic Hepatitis B: A New Look In To Old System
Keywords:
Hepatitis B virus (HBV), HAI score, HBeAg, Anti HBe Antibody, FibrosisAbstract
Background: Hepatitis B virus infection is a global health problem. Histopathological examination is the mainstay in evaluating the disease progression and designing treatment protocols in these patients. The aim of this study is a correlation of histological features with clinical and biochemical parameters and what new could be proposed for the future by analyzing the limitations of scoring system used.
Methods: We evaluated 195 patients of hepatitis B virus infection over a period of 9 years & analysed their clinical & histological features and correlated them. Histological evaluation was done according to modified Ishak’s grading and Scheuer scoring system.
Results: Patients were divided into age groups of < 40 & > 40 years. The majority of the patients were asymptomatic, male sex , younger age & had lower grade and stage. The mean values of total bilirubin and Prothrombin time of patient groups were within the normal ranges. A significant correlation was seen with stage III & IV and presence of HBe antigen & Anti HBe antibody cases [P-value < 0.05].
Conclusions: We concluded that liver biopsy remains the only diagnostic test in evaluating liver pathology in hepatitis B infection. Plan the proper management needs certain modifications in the current existing scoring systems.Â
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2. Bréchot C. Pathogenesis of hepatitis B virus-related hepatocellular carcinoma: old and new paradigms. Gastroenterology. 2004; 127: 56–61.
3. Singh S, Singh PP, Lewis R. Roberts & William Sanchez, Chemopreventive strategies in hepatocellular carcinoma. Nature Reviews Gastroenterology & Hepatology. 2014; 11: 45–54.
4. Ruiz-Moreno M, Otero M, Millan A. Clinical and histological outcome after hepatitis B e antigen to antibody seroconversion in children with chronic hepatitis B. Hepatology. 1999; 29: 572–5.
5. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008; 48: 335–52.
6. Yun-Fan Liaw. HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B. Hepatol Int. 2009; 3: 425–433.
7. ter Borg F, ten Kate FJ, Cuypers HT, Leentvaar-Kuijpers A, Oosting J, Wertheim-van Dillen PM, Honkoop P, Rasch MC, de Man RA, van Hattum J, et al. Relation between laboratory test results and histological hepatitis activity in individuals positive for hepatitis B surface antigen and antibodies to hepatitis B e antigen. Lancet. 1998; 351: 1914–1918.
8. Fong T L, Di Bisceglie A M, Gerber M A. Persistence of hepatitis B virus DNA in the liver after the loss of HBsAg in chronic hepatitis B. Hepatology. 1993; 18: 1313-8.
9. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995; 22: 696–699.
10. Schener PJ. Scoring of liver biopsies: are we doing it right? Europ J Gastroenterol Hepatol. 1996; 8: 1141-43.
11. Di Marco V, Lo Iacono O, Cammà C, et al. The long-term course of chronic hepatitis B. Hepatology. 1999; 30: 257-64.
12. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J. Hepatol. 2008; 48: 335–352.
13. Campbell MS, Reddy KR. The evolving role of liver biopsy. Alimentary Pharmacology & Therapeutics. 2004; 20: 249-259.
14. Brunetto MR, Oliveri F, Coco B, Leandro G. Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: a long-term cohort study. J Hepatol. 2002; 36: 263-70.
15. Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012; 30: 2212-9.
16. Yang CX, Yang WB, Fan JH, et al. Pathological grading analysis of liver biopsies in chronic hepatitis B virus carriers of different age ranges. Zhonghua Gan Zang Bing Za Zhi. 2011; 19: 881-3.
17. Yun-Fan Liaw, Brunetto MR, Hadziyannis S. The natural history of HBV infection and geographical differences. Antiviral therapy. 2010; 15: 25-33.
18. Fattovich G. Natural history and prognosis of hepatitis B. Semin Liver Dis 2003; 23: 47-58.
19. Hoofnagle JH, Shafritz DA, Popper H. Chronic type B hepatitis and the "healthy" HBsAg carrier state. Hepatology. 1987; 7: 758-63.
20. Rozario R, Ramakrishna B. Histopathological study of chronic hepatitis B and C. A comparison of two scoring system. J Hepatol. 2003; 38: 223-29.
21. Tor Borg F, Ten Kate FJ. A survey of liver pathology in needle biopsies from HBsAg and anti-HBe positive individuals. J Clin Pathol. 2000; 53: 541-8.
22. Huo TI, Wu JC, Lee PC, et al. Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis. Hepatology. 1998; 28: 231-6.
23. Sigal SH, Ala A, Ivanov K, et al. Histopathology and clinical correlates of end-stage hepatitis B cirrhosis: a possible mechanism to explain the response to antiviral therapy. Liver Transpl. 2005; 11: 82-8.
24. Peng D, Han Y, Ding H, Wei L. Hepatic steatosis in chronic hepatitis B patients is associated with metabolic factors more than viral factors. J Gastroenterol Hepatol. 2008; 23: 1082-8.
25. Yang JD, Kim WR, Coelho R, et al. Cirrhosis is present in most patients with hepatitis B and hepatocellular carcinoma. Clin. Gastroenterol. Hepatol. 2011; 9: 64–70.
26. Yang LM, Chang K, Zhao YL, Whu ZR. Clinical significance of liver biopsy in chronic hepatitis B patients with persistently normal transaminase. Clin J Diag Dis. 2002; 3: 150-53.
27. Zarski JP, Marcellin P, Cohard M, Lutz JM, Bouche C, Rais A, Group FM. Comparison of anti-HBe-positive and HBe-antigen-positive chronic hepatitis B in France. Journal of hepatology. 1994; 20: 636-640.
28. McMahon BJ, Heyward WL, Templin DW, Clement D, Lanier AP. Hepatitis B-associated clinical and epidemiologic features and long-term follow-up. Hepatology. 1989; 9: 97-101.
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Singh A, Garg B, Sood N, Sood A. Correlation Of Histopathological, Biochemical & Clinical Spectrum Of Chronic Hepatitis B: A New Look In To Old System. Ann of Pathol and Lab Med [Internet]. 2016 Oct. 18 [cited 2025 Feb. 6];3(4):A306-313. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm776
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Copyright (c) 2016 Aminder Singh, Bhavna Garg, Neena Sood, Ajit Sood
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