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KMID : 0816119980010010056
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Korean Journal of Pediatric Gastroenterolology and Nutrition
1998 Volume.1 No. 1 p.56 ~ p.78
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Chronic HBV Infection in Children: The histopathologic classification and its correlation with clinical findings
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Lee Seon-Young
Jang Ja-June
Seo Jeong-Kee
Ko Jae-Sung
Kim Jong-Jae
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Abstract
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Objective: Chronic hepatitis B infection (CHB) occurs in 6% to 10% of population in
Korea. In ethinic communities where prevalence of chronic infection is high such as
Korea, transmission of hepatitis B infection is either vertical (ie, by perinatal infection)
or by close family contact (usually from mothers or siblings) during the first 5 years of
life. The development of chronic hepatitis B infection is increasingly more common the
earlier a person is exposed to the virus, particularly in fetal and neonatal life. And it
progress to cirrhosis and hepatocellular carcinoma, especially in severe liver damage and
perinatal infection. Histopathology of CHB is important when evaluating the final
outcomes. A numerical scoring system which is a semiquantitatively assessed objective
reproducible classification of chronic viral hepatitis, is a valuable tool for statistical
analysis when predicting the outcome and evaluating antiviral and other therapies.
In this study, a numerical scoring system (Ludwig system) was applied and compared
with the conventional histological classification of De Groute. And the comparative
analysis of clinical findings, family history, serology, and liver function test by
histopathological findings in chronic hepatitis B of children was done.
Methods: Ninety nine patients [mean age=9 years (range=17 months to 16 years)] with
clinical, biochemical, serological and histological patterns of chronic HBV infection
included in this study. Five of these children had hepatocellular carcinoma. They were
83 male and 16 female children. They all underwent liver biopsies and histologic
evaluation was performed by one pathologist. The biopsy specimens were classified,
according to the standard criteria of De Groute as follows: normal, chronic lobular
hepatitis (CLH), chronic persistent hepatitis (CPH), mild to severe chronic active
hepatitis (CAH), or active cirrhosis, inactive cirrhosis, hepatocellular carcinoma (HCC).
And the biopsy specimens were also assessed and scored semiquantitatively by the
numerical scoring Ludwig system. Serum HBsAg, anti-HBs, HBeAg, anti-HBe,
anti-HBc (IgG, IgM), and HDV were measured by radioimunoassays.
Results: Male predominated in a proportion of 5.2 : 1 for all patients. Of 99 patients, 2
cases had normal, 2 cases had CLH, 22 cases had CPH, 40 cases had mild CAH, 19
cases had moderate CAH, 1 case had severe CAH, 7 cases had active cirrhosis, 1 case
had inactive cirrhosis, and 5 cases had HCC. The mean age, sex distribution, symptoms,
signs, and family history did not differ statistically among the different histologic
groups. The numerical scoring system was correlated well with the conventional
histological classification. The histological activity evaluated by both the conventional
classification and the scoring system was more severe as the levels of serum
aminotransferases were higher. In contrast, the levels of serum aminotransferases were
not useful for predicting the degree of histologic activity because of its wide range
overlapping. When the histological activity was more severe and especially the cirrhosis
more progressing, the prothrombin time was more prolonged. The histological severity
was inversely related with the duration of seroconversion of HBeAg.
Conclusions: The histological activity could not be accurately predicted by clinical and
biochemical findings, but by the proper histological classification of the numerical scoring
system for the biopsy specimen. The numerical scoring system was correlated well with
the conventional histological classification, and it seems to be a valuable tool for the
statistical analysis when predicting the outcome and evaluating effects of antiviral and
other therapies in chronic hepatitis B in children.
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KEYWORD
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Chronic hepatitis B, Histopathology, Scoring system,
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