Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 4, July-August, p. 681–688

doi: 10.17219/acem/60535

Publication type: original article

Language: English

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Predictors of Liver Disease Severity in Children with Chronic Hepatitis B

Maria Pokorska-Śpiewak1,2,A,B,C,D,E,F, Barbara Kowalik-Mikołajewska1,2,B,E,F, Małgorzata Aniszewska1,2,B,E,F, Magdalena Pluta1,2,B,F, Bożena Walewska-Zielecka3,B,E,F, Magdalena Marczyńska1,2,E,F

1 Department of Children’s Infectious Diseases, Medical University of Warsaw, Poland

2 Hospital of Infectious Diseases, Warszawa, Poland

3 Department of Public Health, Medical University of Warsaw, Poland

Abstract

Background. Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children.
Objectives. The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data.
Material and Methods. The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score.
Results. A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01).
Conclusion. Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury.

Key words

children, liver biopsy, chronic hepatitis, grading and staging, hepatitis B virus

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