OBJECTIVEIn China, liver failure is also termed as severe hepatitis in whom chronic severe hepatitis B (CSHB) is most common. The aim of this study was to assess whether CSHB based on different liver injury extent can meet the international definition of acute-on-chronic liver failure(ACLF)criteria, according by their clinical and pathological feature.

METHODSA total of 91 patients with CSHB were involved in the study. The clinical findings, laboratory data and liver pathology features were retrospectively analyzed and grouped by hepatitis virus B carrier state (HBC), chronic hepatitis B (CHB) or liver cirrhosis (LC) before they started liver failure.

RESULTS74 out of the 91 patients were male and 17 were female, the mean age was 40.6+/-11.2 years. 9.9%, 7.7% and 82.4% of the patients were based on HBC, CHB and LC respectively. The ages of HBC group were youngest. The mean age of HBC group (years) (25.8+/-6.6) was significantly lower than that of CHB group (36.9+/-9.0) and LC group (42.0+/-10.5)with P values of 0.032 and 0.001 respectively. Most cases presented with sub-acute liver failure characterized by high icterus and ascites. Predisposing factors included exertion, superinfection, virus variation, drugs or alcoholic injury. No difference found between PTA (F = 0.906, P = 0.408) and TBil (F = 0.839, P = 0.436) among the above three groups. The Alb and CHE levels in LC group were (30.3+/-5.1) g/L and (2926.8+/-1471.1) U/L respectively, which were lower than both HBC group [Alb (35.6+/-5.1) g/L, CHE (4363.5+/-2063.2) U/L] and CHB group [Alb (37.4+/-5.0) g/L, CHE (5167.1+/-1522.1) U/L] (F = 9.450; F = 9.297; P value less than 0.01).The level of CHO (1.8+/-1.0) mmol/L in LC group was lower than that of HBC group (2.9+/-1.0mmol/L, P = 0.034), while serum HBV DNA level of HBC group [(6.8+/-1.7) log10copies/ml] was higher than that of LC group [(4.2+/-2.6) log10copies/ml]. The liver tissue in HBC and CHB group showed massive or submassive necrosis which distribute evenly in different parts of liver and similarly in slides, most like acute/subacute severe hepatitis. The chronic lesion was easily covered by extensive necrosis in CSHB based on CHB, with portal fibrosis can be seen by masson stain. Characteristic picture of LC group were massive or submassive necrosis with some nodules were intact or only patchy necrosis of the parenchyma, disparity of extent and stage of necrosis existed in slides, which were the major difference in histopathological change in HBC and CHB group.

CONCLUSIONMost of CSHB cases were based on liver cirrhosis, which match with the international definition of ACLF, while small part of CSHB cases based on HBC and CHB are identical to acute/subacute liver failure.

Adult ; Carrier State ; pathology ; virology ; Female ; Hepatitis B, Chronic ; pathology ; Humans ; Liver Cirrhosis ; pathology ; virology ; Liver Failure ; etiology ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study the correlations between clinical features and liver pathohistological changes of chronic hepatitis B virus (HBV) carriers and to discuss the factors which may influence the prognosis.

METHODSNinety HBV carriers who had liver biopsies were enrolled in this study.

RESULTS(1) The mean follow-up period of the patients was 118 weeks. (2) Fifty-four patients (60.0%) had G1 hepatitis and 21 (23.3%) had G2 hepatitis. The fibrosis stages were graded as S1(42) and S2(21). (3) There were significant age differences among S0, S1 and S2. (4) There were significant differences in aminotransferase levels between patients who had a normal liver histology and those who had mild hepatitis. (5) The grades of liver inflammation were not correlated with the titers of HBeAg and HBV DNA in sera. The stages of liver fibrosis were not correlated with the titers of HBVDNA in sera. Most of the HBeAg negative patients progressed to S2. (6) There were significant differences in spleen dimensions measured by ultrasonography between S0, S1 and S2 patients. (7) During the follow-up period serum aminotransferase (ALT) levels remained normal in 60 patients (group A); 22 patients had transient elevations (group B), and 8 patients had persistent increases (group C). There were significant differences of the ratios of S0 and S2 cases among patients in groups A, B and C. (8) Age and fibrosis stages were predictive factors of liver cirrhosis.

CONCLUSIONSMost chronic HBV carriers had mild inflammatory histological changes in their livers and also had different degrees of liver fibrosis. This follow-up study shows that some of those carriers should have had antiviral therapy.

Adult ; Carrier State ; diagnosis ; pathology ; virology ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; diagnosis ; pathology ; Humans ; Liver Cirrhosis ; diagnosis ; pathology ; virology ; Male ; Middle Aged ; Prognosis

OBJECTIVETo investigate the relationship between hepatic histopathological changes and clinical characteristics in chronic HBV carriers.

METHODA retrospective analysis was performed based on the hepatic biopsy findings, clinical laboratory results, and ultrasound examinations in 142 chronic HBV carriers. The patients were divided into two groups according to their serum HBV DNA replication and the pathological alterations in their livers.

RESULTSThe average age of the 142 patients was (24.8+/-8.7) years old. Among them, 129 were diagnosed as chronic HBV carriers based on their positive HBV DNA results. Thirteen were diagnosed as non-active HBsAg carriers. Hepatitis B family history was found in 31.0% of the cases. Normal liver tissues (G0S0) were found in the specimens of 33 cases (G > or = 1 and/or S > or = 1) chronic hepatitis B was diagnosed based on the biopsies in 106 cases, including an early stage of hepatic cirrhosis in 1 case (G4S4). There were no obvious differences between HBV DNA positive and negative group cases. The levels of HBV DNA in all the 129 cases of chronic HBV carriers were more than 1.0 x 10(4) copy/ml and the average value was (7.58+/-0.99) log10 copy/ml. Of the 129 cases, 123 were HBeAg positive (95.3%). Increased levels of gamma-globulin were detected in 45.8% of the cases and fibrosis index increased in 37.1%; 40.1% of the cases showed abnormalities in their ultrasound examinations. The average PCIII value of the chronic HBV carrier group (G > or = 1 and/or S > or = 1) was higher than that of the non-active HBsAg carrier group (P = 0.016). Spearman's analysis indicated that the inflammation grade (G) was correlated with the hepatic fibrosis index PCIII, and the correlation coefficient was 0.391 (P = 0.003).

CONCLUSIONThe patients in our study have a higher HBV DNA replication in their sera and have mild inflammation in their livers. Inflammation grade (G) and fibrosis stage (S) have no correlation with the level of HBV DNA or the state of HBeAg positivity. The increased level of PCIII might be related to their hepatic inflammation.

Adolescent ; Adult ; Carrier State ; pathology ; Child ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Adolescent ; Adult ; Carrier State ; pathology ; psychology ; Female ; Hepatitis B ; pathology ; psychology ; Hepatitis B virus ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Young Adult

Asymptomatic chronic HBsAg carriers with normal liver function tests are, in general regarded as having no liver pathology. Most of the histologic findings in asymptomatic chronic carriers have been reported from areas with low incidence of Hepatitis B virus (HBV) infection, such as North America and Western Europe. It is well known that there are many differences in HBV infection between low and high endemic areas, but there have been few reports on the histologic findings of asymptomatic chronic HBsAg carriers from endemic areas. The present study was undertaken in Korea which is one of the endemic areas for HBV infection and was designed to assess the prevalence of chronic liver disease by peritoneoscopic liver biopsy among asymptomatic chronic HBsAg carriers and to make a basis for the follow-up of asymptomatic chronic HBsAg carriers according to the results obtained. One hundred and ten asymptomatic HBsAg-positive carriers with normal liver function tests and no hepatomegaly were included in the study. Final diagnosis by peritoneoscopic liver biopsy revealed that of the 110 asymptomatic carriers only 27 (24.5%) had a histologically normal liver, while 51 (46.4%) had chronic liver diseases, and the remaining 32 (29.1%) had nonspecific histologic abnormalities (nonspecific reactive changes in 18 cases, cholestasis in 6 cases, and fatty change in 8 cases). Of the 51 patients with chronic liver diseases, 3 had liver cirrhosis, 4 chronic active hepatitis with cirrhosis, 11 chronic active hepatitis and 33 chronic persistent hepatitis. The frequency of liver cirrhosis and chronic active hepatitis with cirrhosis was significantly high in the over 30 years of age group (12.1%) than in the under 30 years of age group (0%; p = 0.011 by Fisher's exact test). In conclusion, 46.4% of the Korean asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly had chronic liver disease. This finding contrasted with reports from low incidence areas of HBV infection. Our results suggest that in endemic areas, a liver biopsy should be considered to assess the status of liver disease in asymptomatic chronic HBsAg carriers even if liver function tests are normal and hepatomegaly is absent, and the result can be used as a basis for the follow-up of each asymptomatic chronic HBsAg carriers.
Adolescent ; Adult ; Biopsy ; Carrier State/*pathology ; Chronic Disease ; Female ; Hepatitis B/*pathology/physiopathology ; Hepatitis B Surface Antigens/*analysis ; Human ; Laparoscopy ; Liver/*pathology/physiopathology ; Male ; Middle Age

OBJECTIVETo study of serum level of cortisol and peripheral T lymphocyte subsets state in the hepatitis B virus (HBV) carriers.

METHODSSixty chronic HBV carriers and ten healthy controls were all enrolled in this present study. Serum expression of cortisol was determined by radioimmunoassay, and also flow cytometry was performed to evaluate peripheral blood T lymphocyte subset.

RESULTSCompared with those in normal controls, the serous levels of cortisol in chronic HBV carriers were significantly elevated, while there was no distinct difference in the proportion of CD4+ T lymphocytes ( P > 0.05) with the decreased odds of CD4+/CD8+ lymphocytes( P < 0.05) and obvious higher proportion of CD8+ T lymphocytes( P < 0.05). In comparison between HBeAg positive group and HBeAg negative group, the serous levels of cortisol of the former group were significantly higher ( P < 0.05), and so proportion of CD8+ T was too ( P < 0.05). However, there is no significant differences in the proportion of CD4+ T lymphocyte ( P > 0.05).

CONCLUSIONThe elevated serum cortisol and increased CD8+ T lymphocytes subsets in the chronic HBV carriers, suggested that there was disturbance of endocrine-immune response in the chronicity of HBV infection.

Adult ; Carrier State ; immunology ; pathology ; virology ; Female ; Hepatitis B ; blood ; immunology ; metabolism ; pathology ; Hepatitis B virus ; immunology ; Humans ; Hydrocortisone ; blood ; immunology ; Male ; T-Lymphocyte Subsets ; immunology

OBJECTIVETo study the liver histopathological features of chronic HBV carriers and inactive HBsAg carriers.

METHODSLiver biopsies were performed on 189 chronic HBV carriers and 30 inactive HBsAg carriers (219 cases in total). All of them had a normal serum ALT value; they were then followed-up for more than 6 months. HBsAg and HBcAg were detected by immunohistochemistry. The circulating HBV DNA loads and serologic markers of HBV were examined at the same time. Grades of liver necrosis/inflammation and fibrosis were compared between the patients regarding their HBV DNA positivity or negativity. The relationships between the HBeAg positivity and degrees of liver histological changes were evaluated. The grades of liver necrosis/inflammation and fibrosis were compared between three age groups: younger than 18 years, 18-40, and older than 40 years.

RESULTSTwo hundred eight carriers of the total 219 (95.0%) had histological liver changes. Fifty percent (104/208) of them had mild histological changes (G0-1/S0-1), while more severe changes (G3-4 and/or S3-4) were found in 18 out of the 208. There were no significant differences in the grades of liver necrosis/inflammation and fibrosis between the chronic HBV carriers and the inactive HBsAg carriers. Among the serologic HBV DNA positive carriers, hepatic fibrosis was more severe in the HBeAg negative group than in the positive group (chi2 = 9.551, P = 0.008), but no differences of the necrosis/inflammation grades were seen between the two groups. The rate of severe fibrosis (S3-4) was 21.1% in those carriers older than 40 years but was 7.7% in patients younger than 18 years. However, no statistically significant differences in degrees of liver inflammation and fibrosis were found among the three age groups. HBcAg positive rate was 100% in the liver tissues of all the chronic HBV carriers, but only in 33.3% in the inactive HBsAg carriers.

CONCLUSIONSThe majority of our HBV carriers have liver inflammation and fibrosis. More severe histological changes were found in 8.65% of them. Liver fibrosis existed in the carriers with negative HBeAg and in those older than 40 years. HBcAg was found in hepatic tissues while their serological HBV DNA was negative.

Adolescent ; Adult ; Carrier State ; pathology ; virology ; Child ; Female ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Young Adult

OBJECTIVESTo study the relationship between liver pathology and clinical characters of chronic HBV carriers.

METHODSAnalyze the age, sex, grade of liver inflammation and stage of liver fibrosis among patients with chronic HBV carriers (n = 58) and non-active HBsAg carriers (n = 32), and compare the grade of liver inflammation and stage of liver fibrosis in different groups according to age, ALT levels and with/without HBeAg. The data was processed by using t test or Chi-square test for statistical analysis, respectively.

RESULTS(1) No differences existed in gender composition ratio between chronic HBV carriers and non-active HBsAg carriers. However, the ages of non-active HBsAg carriers group (35.2+/-7.6) were much older than that of the HBV carriers group (24.7+/-4.8) (t = 2.576, P = 0.017). (2) The stage of liver fibrosis in non-active HBsAg carriers group was more aggravated than that of the chronic HBV carriers group (Chi-square = 23.231, P less than 0.01), whereas no significant differences existed between these 2 groups (Chi-square = 0.058, P = 0.972). (3) As to the grade of liver inflammation and the stage of liver fibrosis, significant differences existed between the groups with higher level of serum ALT (20-40 U/L) and lower level ( is less than or equal to 20 U/L) (Chi-square = 7.827, P = 0.008; Chi-square = 14.303, P = 0.001), and similar results also existed between elder group (more than 40) and younger group (is less than or equal to 40) (Chi-square = 10.949, P = 0.001; Chi-square = 21.271, P less than 0.01); (4) Among the chronic HBV carriers, significant differences existed in grade of liver inflammation between groups with HBeAg positive and negative patients (Chi-square = 10.275, P = 0.002), and the latter was more aggravated; however, there was no difference in stage of liver fibrosis between them (Chi-square test = 3.457, P = 0.178).

CONCLUSIONLiver histopathology can be recommended to guide the clinical diagnosis and treatment, especially for the chronic HBV carriers, with elder age, ALT close to normal and HBeAg negative.

Adolescent ; Adult ; Age Factors ; Biopsy ; Carrier State ; pathology ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo explore Chinese medicine (CM) syndrome distribution of chronic hepatitis B virus (HBV) carriers in immunotolerant phase (ITP).

METHODSOne hundred and eighty-five chronic HBV carriers in ITP, seen in the Third Affiliated Hospital of Sun Yat-sen University from May 2009 to December 2010, were admitted in an observational study under the guidance of CM. Patients' CM symptoms and signs, demographics, liver biochemistries, and qualitative HBV DNA were recorded in the questionnaires. CM syndromes were then differentiated to 15 detailed types and analyzed by generalization. Lastly, the location, pathogenic factors and nature of the disease were also assessed.

RESULTSWhen CM syndrome patterns were differentiated to 15 types, there were 27 (15%) no syndrome cases, 94 (50%) single syndrome cases and 64 (35%) compound syndromes cases. The main detailed syndromes included Liver (Gan)-qi depression (LQD), Kidney (Shen)-qi deficiency (KQD), Spleen (Pi)-qi deficiency (SQD) and Kidney-yang deficiency (KYAD). After CM syndromes generalized to five types, their frequency was Spleen-Kidney deficiency (SKD)>LQD>inner dampness-heat retention (IDHR)>Liver-Kidney deficiency (LKD)>blood stasis blocking collateral (BSBC). SKD and LQD occupied 64%. The disease location included Liver, Gallbladder (Dan), Spleen, Stomach (Wei) and Kidney. The pathogenic factors were mainly qi stagnation, qi deficiency, yang deficiency, concurrently dampness-heat and blood stasis. The deficiency syndrome was more than excess syndrome in its nature.

CONCLUSIONSMost of chronic HBV carriers in ITP have their CM syndrome, and the most common types are SKAD, LQD. This study suggests that the natural history may be improved through breaking the state of immune tolerance or shorten the time of ITP by strengthening Spleen-Kidney and reliving Liver qi.

Adolescent ; Adult ; Biopsy ; Carrier State ; immunology ; Child ; Child, Preschool ; Female ; Hepatitis B virus ; physiology ; Hepatitis B, Chronic ; immunology ; pathology ; virology ; Humans ; Immune Tolerance ; Liver ; immunology ; pathology ; virology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Syndrome ; Viscera ; pathology ; Young Adult

OBJECTIVETo establish non-invasive predictors of antiviral therapy for chronic HBV carriers.

METHODSLiver biopsies were performed in 139 chronic HBV carriers. Seventeen of them were histopathologically graded as G > or =2 or S > or =3, being considered in need of antiviral therapy. The other 122 subjects with grades G < 2 and S < 3 were not applicable for antiviral therapy. Independent predictors were analyzed using logistic regression (Backward). The covariates included age, gender, duration of HBV infection, family history of hepatitis B, HBeAg positivity, quantitive HBeAg, level of LN, PCIII, HA, CIV and gamma-globin, low white blood cell count, spleen measurement and HBV load. ROC curve was used to define the diagnostic critical value.

RESULTSLogistic regression analysis showed that PCIII, but not other factors, was related to antiviral therapy in these HBV carriers (OR = 1.122). When the diagnostic critical value was 85.02 ng/ml, 100.79 ng/ml and 105.50 ng/ml, its sensitivity was 80.0%, 67.3% and 54.8%, respectively; its specificity was 52.0%, 70.6% and 84.2%, respectively. The area under ROC curve was 70.8%.

CONCLUSIONPCIII might be a reference index for predicting antiviral therapy in chronic HBV carriers, but liver biopsy is still a non-substutiable reference index.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Carrier State ; drug therapy ; virology ; Child ; Female ; Hepatitis B ; Hepatitis B, Chronic ; drug therapy ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Treatment Outcome ; Young Adult