Téma: 

Chronic hepatitis c – analysis of histomorphological and selected clinical parameters of disease

Vladimír Bartoš, Dušan Krkoška, Pavol Slávik, Ľudovít Lauko, Katarína Adamicová, Marián Adamkov

Introduction: Chronic hepatitis C is one of the most frequent and most important hepatic disorders all over the world. A diagnostics of this infectious disease is complex and includes an examination of basic serological, biochemical and histomorphological markers. The aim of the study: The aim of the present study was a retrospective analysis and correlation of characteristic histological findings and selected clinical parameters (age, ALT, AST) of disease in patients with chronic hepatitis C. Material and methods: A 58 chronically HCV-infected patients that they had been undertaken core needle liver biopsy were considered in the study. The biopsy materials were fixed in buffered formalin, embedded in paraffin blocks, stained with hematoxylin-eosin and special histochemical methods and after complete processing examined by pathologist. Histological grading and staging of hepatitis were evaluated according to Ishak’s mHAI criteria, degree of steatosis was classified in 5 groups proposed by Wyatt. We used only descriptive evaluation for other histomorphological findings (iron and bile accumulation, bile duct alteration). Results: Chronic hepatitis with histological activity G 1, G 2, G 3, G 4 were manifest in 15,5 %, 63,8 %, 15,5 % and 5,2 % of the cases, while portal fibrosis PF 1-2, PF 3-4, PF 5, PF 6 in 65,5 %, 22,5 %, 8,6 % and 1,7 %, retrospectively. The most common finding (46,5 %) was hepatitis with mild necro-inflammatory activity and mild fibrosis. ALT levels in serum statistically more correlated with grading (p < 0,001) than staging (p = 0,012). AST levels showed association with grading (p < 0,001) but not with staging (p = 0,08). We revealed 7 and 23 cases with normal ALT and AST activity, retrospectively. Steatosis was present in 60,3 % cases and it was associated with age (p = 0,009) but not with fibrosis (p = 0,7). Conclusion: Although most chronic hepatitis C patients displayed only mild histological damage and mostly ALT levels correspond with histological activity of disease, normal level of hepatic enzymes did not exclude even serious microscopic liver damage. The other histomorphological findings are also important diagnostic features that can show strong correlation with chronic hepatitis activity. Therefore, these facts should in general alert the clinicians for the need of liver biopsy.

Ročník 2007  Témy časopisu Internal medicine 6 / 2007

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