Chronic Active Hepatitis Group Research Articles

Association between IL-22 polymorphism (Rs1179251) and outcomes of HBV infection

BackgroundGenetic variations can play an essential role in the modulation of immune system responses. Interleukin-22 (IL-22) is a recently discovered cytokine of the IL-10 family that can affect the immune response to cancer, inflammation, and infections. Therefore, its polymorphisms might influence the HBV infection outcome. AimThis study aimed to evaluate rs1179251 single nucleotide polymorphism in the IL-22 gene as a host genetic factor and its effect on hepatitis B infection outcome. MethodsDNA was extracted from 100 HBV-infected patients with cirrhotic/hepatocellular carcinoma (C/HCC), 100 patients with chronic active hepatitis (CAH), 100 asymptomatic healthy carriers (HC) and 58 individuals that their infection was spontaneously cleared (SC). IL-22 rs1179251 single nucleotide polymorphism (SNP) was then genotyped in all cases using PCR-RFLP method. ResultsThe results of rs1179251 genotyping demonstrated that G allele in HC (30%) was significantly more frequent than CAH group (17%) (P = 0.003). HC cases also inherited more CG genotype (46%) than CAH group (28%) (P = 0.006) but less GG genotype (7%) than SC group (13.8%) (P = 0.01). ConclusionOur findings collectively suggest that CG and GG genotype or generally G allele of rs1179251 in IL-22 gene might have a protective role against HBV infection. However how it can be involved in the immune system to deactivate the virus remained to be elucidated.

Development of hepatocellular carcinoma from various phases of chronic hepatitis B virus infection.

Background & aimsThere is insufficient data on the clinical course of chronic hepatitis B (CHB) patients in the immune-tolerant (IT) and immune-clearance, inactive (IC) phases over a long follow-up period.DesignWe enrolled 466 CHB patients from our historical cohort, including 56 IT+MA (mildly active), 134 IC, 230 with chronic active hepatitis (CH) and 46 with liver cirrhosis (LC), who were categorized to each phase by at least one year of follow-up period from the first visit to our hospital. We investigated long-term risks, and their factors, of developing hepatocellular carcinoma (HCC), and the transition between the clinical phases, especially in the IT+MA and IC groups.ResultsOf the 56 patients in the IT+MA group, 27 remained the IT+MA phase, but 29 transitioned to the CH phase and started nucleot(s)ide analogue (NA) treatment during the follow-up period. Meanwhile, of the 134 patients in the IC group, only 5 started NA treatment after progressing to the CH phase. The development of HCC from the IT+MA, IC, CH, and LC groups was observed in 2, 2, 9, and 20 cases, respectively. The cumulative incidence rates of developing HCC in the IT+MA, IC, CH, and LC groups were 9.9, 1.8, 3.0, and 53.1% at 10 years. In the CH and LC group, patients who developed HCC were older, had higher levels of FIB-4 index, M2BPGi, HBcrAg and AFP, and had lower levels of albumin and platelet counts. In CH patients, FIB-4 index levels were elevated at the diagnosis of HCC compared to baseline, whereas these decreased during the follow-up period in non-HCC patients.ConclusionsHCC occurred at a certain rate among patients in the IT+MA and IC groups. Careful follow-up is required for CH patients with higher levels of FIB-4 index and/or M2BPGi because of the high incidence of HCC development. (299 words)

Cfa-miRNAs-122 and -21 as modern biomarkers of primary hepatitis in dogs

Primary hepatitis (PH) is one of the most frequently diagnosed hepatic diseases in dogs. Its popular forms are acute hepatitis (AH) and chronic active hepatitis (CAH) which can progress to hepatic fibrosis and cirrhosis. This investigation aimed to evaluate the use of hepatocyte released Canine familiaris miRNAs(cfamiR)-122 and -21 as serum biological markers for the early and reliable diagnosis of PH and to reveal the onset of hepatic fibrosis. After the ultrasonographic and histological examination, fifteen healthy dogs were involved in the study as control group to compare with other thirty dogs confirmed to have AH or CAH (n = 15). Activity of liver enzymes as well as serum level of globulin and total bilirubin were significantly elevated in AH (P 0.001) and CAH (P 0.01) groups whereas, serum level of total protein, albumin, BUN and A/G ratio were significantly lowered in both PH groups (P 0.01) compared to control. Cfa-miR-122 significantly expressed in AH (P 0.001) and CAH (P 0.01) and exhibited a potential significance in distinguishing these groups from control with an area under the curve (AUC) of 0.98 and 0.96, respectively. Additionally, cfa-miR-122 displayed a potential role in distinguishing AH (P 0.05) from CAH group with an AUC of 0.85. Cfa-miR-21 was only expressed in dogs of CAH group and displayed a potential role in distinguishing this group (P 0.001) from AH and healthy groups with an AUC of 0.99 and 0.88, respectively. Therefore, cfa-miR-122 can be significantly expressed in dogs with two forms of PH whereas, cfa-miR-21 could be potentially enhanced only in chronic form of PH and may act as new non-invasive biomarker for distinguishing AH from CAH.

Aminotransferases in Chronic Active and Chronic Persistent Hepatitis

Chronic active hepatitis (CAH) and chronic persistent hepatitis (CPH), the two histologically distinct forms of viral hepatitis present with variable clinical features. So liver function tests play the key role in diagnosis and prognosis of these disorders. Among the liver function tests, determination of serum aminotransferases: aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio are still popularly used. In fact over the transaminase tests no other enzymatic tests have any particular value. In infiltrative disorders there is damage to both mitochondrial and cytoplasmic membranes. Therefore there is a proportionally greater increase in plasma AST activity than ALT. This comparative study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka from January 2007 to December 2007 to observe the role of aminotransferases and AST/ALT ratio in CAH and CPH. With prefixed inclusion and exclusion criteria a total of 44 age and sex matched subjects were purposively enrolled in the study. Out of them 20 were CAH and 24 were CPH. Serum AST, ALT and total bilirubin were measured and AST/ALT ratio were calculated. Mentioned parameters were compared between groups. Unpaired student's t-test and chi (x2) square test were done to detect the significant difference between the groups using SPSS version 12.0. Mean age of the study subjects in CAH and CPH group were 32.20 ± 10.65 years (20-50 years) and 32.83 ± 10.68 years (20-49 years) respectively. There was no significant difference regarding age and sex distribution between the groups (p > 0.05). Mean ± SD serum AST was 295.08 ± 153.77 IU/L and 73.38 ± 45.72 IU/L and ALT was 352.44 ± 206.95 IU/L and 121.01 ± 58.77 IU/L in CAH and CPH respectively and both were statistically highly significant (p < 0.01). Mean ± SD of AST / ALT ratio in CAH and CPH were 0.87 ± 0.14 and 0.59 ± 0.14 respectively and was highly significant (p < 0.01). There was no significant difference in serum bilirubin level between the groups (20.78 ± 14.16 ?mol/L vs. 19.25 ± 15.90 ?mol /L) (p > 0.05). DOI: http://dx.doi.org/10.3329/bmj.v41i2.18795 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 17-19

Tissue Polypeptide Specific Antigen as a Marker Used to Determine the Liver Diseases

Tissue polypeptide specific antigen and its specific M3 epitope are increased in malignant as well as in some benign diseases. The level of tissue polypeptide specific antigen in serum is related mostly to proliferation capacity rather than tumor mass and cell necrosis. The aim of this study was to evaluate the levels of tissue polypeptide specific antigen and other tumor markers in patients with liver cirrhosis, chronic active hepatitis and hepatoma to determine if tissue polypeptide specific antigen is important to other tumor markers in hepatoma patients. Ninety-seven patients and 30 controls were included in the study. The patients were divided into three subgroups as cirrhosis, hepatoma and chronic active hepatitis. The levels of tissue polypeptide specific antigen, carcinoembryonic antigen, CA19.9, alpha-fetoprotein and transaminases were determined in all patients. Tissue polypeptide specific antigen levels were significantly higher in all patients than in the control group (p less than 0.005) According to Kruskal-Wallis test with regard to subgroups, the differences in mean values of tissue polypeptide specific antigen and alpha-fetoprotein were significant (p less than 0.0001 for both). There was a low correlation between tissue polypeptide specific antigen and alpha-fetoprotein in the cirrhotic and hepatoma groups, but these were significantly correlated in the chronic active hepatitis group. The correlation coefficient between tissue polypeptide specific antigen and transaminases in all patients was low. Tissue polypeptide specific antigen is efficient for determining primary hepatoma patients and also that this marker is specific for proliferation of cells.

Impact of Viral Hepatitis on Apo- and Lipoprotein Status in Blood

Objectives:To investigate the effect of viral hepatitis on serum levels of apo- and lipoproteins in different forms of liver diseases. Materials and Methods: One hundred and thirty adult patients and 100 healthy age- and gender-matched control individuals participated in this study. Patients were grouped according to four types of liver disease: acute viral hepatitis, chronic active hepatitis (CAH), cirrhosis of the liver and fulminant hepatic failure. Results: Hepatitis B virus, C virus and E virus (HEV) infections were recorded in different combinations in these patients, but viral infections of hepatitis A and D were not seen in any of the patient groups. The results of lipo- and apoprotein analysis showed different patterns. The low-density lipoprotein value was high in the CAH group. In the other three groups, low-density lipoprotein level was comparable to the control value. The high-density lipoprotein level (p = 0.02) was significantly low in all groups except in the cirrhosis group. Apo-A was significantly reduced in the acute viral hepatitis and fulminant hepatic failure groups, whereas Apo-B level was low in the CAH and cirrhosis groups. The lipoprotein (a) level in these groups was low, compared to control. Conclusion: No apparent relationship was observed between etiological viruses and ensuing changes in lipid/lipoprotein profile.

Circulating adhesion molecules in patients with virus-related chronic diseases of the liver

In the inflammatory state, intercellular adhesion molecule-1 (ICAM-1) and vascular cellular adhesion molecule-1 (VCAM-1) play a key role in promoting migration of immunological cells from the circulation to target site. Aim of our study was to investigate soluble forms of these molecules in patients with virus-related chronic liver diseases, to assess their behavior in different pathologies and correlation with severity of liver damage. Circulating ICAM-1 and VCAM-1 were assayed by EIA commercial kits (R and D System Co., Abington, UK) in 23 patients with chronic active hepatitis (CH), 50 subjects affected by liver cirrhosis (LC) and 15 healthy controls comparable for sex and age. In patients, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also detected by autoanalyzer. LC patients had significantly higher ICAM-1 values than CH patients (38.56+/-7.4 ng/mL vs 20.89+/-6.42 ng/mL; P < 0.001) and these ones had significantly higher values than controls (12.92+/-1.08 ng/mL; P < 0.001). In CH group, ICAM-1 levels were significantly related to inflammatory activity (P = 0.041) and ALT values (r = 0.77; P < 0.05). VCAM-1 values were significantly increased only in LC patients (P < 0.001) and related to severity of liver impairment. These findings suggest that the determination of serum ICAM-1 can be considered as an additional useful marker of hepatocellular necrosis and inflammatory activity in chronic hepatitis, while serum VCAM-1 is an indicator of liver fibrogenesis and severity of disease in cirrhosis.

Superoxide dismutase and total anti-oxidant levels in various forms of liver diseases

In order to understand the impact of viral hepatitis on anti-oxidant defence system of the body, blood levels of superoxide dismutase (SOD), an enzymatic anti-oxidant, and total anti-oxidant (TAO) were evaluated and co-related to etiological viral hepatitis in various forms of liver diseases. A total number of 110 patients including 50 patients with acute viral hepatitis (AVH), 30 patients with chronic active hepatitis (CAH) and 30 patients with cirrhosis of liver were analysed for different hepatitis viral markers and the anti-oxidant levels in their blood. For comparison, blood from 100 healthy persons were also simultaneously tested for anti-oxidant levels. Analysis of results indicated that none of the patients belonging to these three liver diseases had hepatitis A viral (HAV) and hepatitis D viral (HDV) infections. AVH group had mainly hepatitis B viral (HBV), hepatitis C viral (HCV) and hepatitis E viral (HEV) infections, CAH group had B and C infections and cirrhosis group had B, C and E infections. A sizeable number of patients in each group had no markers and were labelled as non-BCE group. On co-relating anti-oxidant levels to viral etiology in these patients, it was observed that in comparison to healthy control group, SOD level was significantly reduced in all the patients irrespective of the viral etiology ( P<0.05–0.001). The impact of different viruses on reduction in SOD level was recorded to be the same with no significant difference in SOD level between any two viral infections. On the contrary, TAO level in the majority of patients was found to be comparable with that observed in healthy persons. An appreciable change in SOD level but little impact on TAO level during viral hepatitis may be explained by the possible adaptive rise of some other anti-oxidant level in the blood of these patients.

Hepatitis C genotypes and subtypes in Saudi Arabia

Hepatitis C virus (HCV) genotypes are diverse geographically. Infectivity, pathogenicity, and sustained response to treatment may be influenced by HCV genotypes/subtypes. This study examined the relative distribution of hepatitis C genotypes and subtypes among isolates from 84 individuals with chronic active hepatitis (CAH), 39 haemodialysis patients, and 31 intravenous drug addicts, of Saudi Arabian origin. Reverse transcription-polymerase chain reaction (RT-PCR) using specific primers from the 5′-UTR was performed and amplified products were genotyped/subtyped using a commercial reverse phase hybridisation technique (Innolipa HCV 11, Innogenetics, Belgium). Seventy-four percent of the CAH patients were found to be genotype 4 (4c/4d: 33%; 4h: 14%; 4e: 7%; 4: 20%) but other subtypes such as 1b: 14%, 2b: 4%, 3a: 5%, 5a: 1%, and 6a: 1%, were also detected. A history of blood transfusion was disclosed in only 10% of the CAH group. The pattern among haemodialysis patients was as follows: genotype 4: 49% (4h: 13%; 4: 36% ); 1a: 33%, 1: 3%; 1b: 10%; and 5a: 5%. The intravenous drug addict group showed 39% subtype 1b, but other subtypes such as 9% for 1a; 3% for 2a; 36% for 4; 3% for 5a; and 9% for 3a were seen. It is concluded that genotype 4 is predominant among our HCV isolates from CAH patients but subtype 1a and 1b have emerged among our haemodialysis and intravenous drug addict cases, respectively. A significant relationship between the viral genotype and the source of infection has emerged among Saudi groups at high risk for hepatitis C virus. J. Med. Virol. 58:44–48, 1999. © 1999 Wiley-Liss, Inc.

Hepatitis C genotypes and subtypes in Saudi Arabia

Hepatitis C virus (HCV) genotypes are diverse geographically. Infectivity, pathogenicity, and sustained response to treatment may be influenced by HCV genotypes/subtypes. This study examined the relative distribution of hepatitis C genotypes and subtypes among isolates from 84 individuals with chronic active hepatitis (CAH), 39 haemodialysis patients, and 31 intravenous drug addicts, of Saudi Arabian origin. Reverse transcription-polymerase chain reaction (RT-PCR) using specific primers from the 5'-UTR was performed and amplified products were genotyped/subtyped using a commercial reverse phase hybridisation technique (Innolipa HCV 11, Innogenetics, Belgium). Seventy-four percent of the CAH patients were found to be genotype 4 (4c/4d: 33%; 4h: 14%; 4e: 7%; 4: 20%) but other subtypes such as 1b: 14%, 2b: 4%, 3a: 5%, 5a: 1%, and 6a: 1%, were also detected. A history of blood transfusion was disclosed in only 10% of the CAH group. The pattern among haemodialysis patients was as follows: genotype 4: 49% (4h: 13%; 4: 36% ); 1a: 33%, 1: 3%; 1b: 10%; and 5a: 5%. The intravenous drug addict group showed 39% subtype 1b, but other subtypes such as 9% for 1a; 3% for 2a; 36% for 4; 3% for 5a; and 9% for 3a were seen. It is concluded that genotype 4 is predominant among our HCV isolates from CAH patients but subtype 1a and 1b have emerged among our haemodialysis and intravenous drug addict cases, respectively. A significant relationship between the viral genotype and the source of infection has emerged among Saudi groups at high risk for hepatitis C virus.

Serum Lipid and Lipoprotein Patterns in Patients With Liver Cirrhosis and Chronic Active Hepatitis

An impaired lipid metabolism is often found in patients with chronic liver diseases. Unfortunately, few studies are available concerning serum lipid and lipoprotein levels in patients with liver cirrhosis and chronic active hepatitis (CAH). To evaluate low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and total cholesterol serum levels in patients with cirrhosis and CAH and control patients and to relate the findings to the severity of the cirrhosis (Child classification). We measured the serum lipid pattern in 34 consecutive patients with liver cirrhosis (15 men and 19 women; mean [+/-SD] age, 55 +/- 14 years; Child classes: 14 in A, 9 in B, 11 in C; patients with biliary cirrhosis were excluded), 34 patients with CAH, and 34 control patients. The 3 groups were matched for sex and age. Total serum, HDL cholesterol, and triglyceride levels were measured by enzymatic methods; serum LDL and VLDL levels were calculated. In patients with cirrhosis, there was a significant decrease in LDL, HDL, and total cholesterol serum levels compared with both the patients with CAH and the control patients, while the VLDL cholesterol level in patients with cirrhosis was significantly lower compared with the control patients alone. A significant decrease in total cholesterol levels was also observed in the CAH group when compared with the control patients. In patients with cirrhosis, levels of LDL, HDL, and total serum cholesterol were progressively lower when comparing patients in Child class A with patients in class C. In this study, the striking decrease in the level of serum LDL cholesterol in patients with liver disease was related to the increasing severity of the disease. Accordingly, the assessment of the serum LDL cholesterol level is important for an effective treatment and prognostic evaluation of patients with chronic liver disease.

Hepatitis D virus (HDV) infection in severe forms of liver diseases in north India.

Preliminary reports indicate that hepatitis D virus (HDV) infection exists in India. However, its prevalence in patients with different types of liver diseases has not been studied in detail. The aim of this study was to evaluate the status of HDV infection in severe types of liver disease in India. Using commercial kits for various hepatitis viral markers, the present study was undertaken to determine the serological status of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers in 208 patients with severe liver diseases. This total included 110 cases with fulminant hepatic failure (FHF), 65 cases with subacute hepatic failure (SHF) and 33 cases with chronic active hepatitis (CAH). The hepatitis B surface antigen (HBsAg) carrier population, indicated by the presence of HBsAg without IgM anti-HBc (hepatitis B core) in serum, was recorded in 23.6%, 24.6% and 60.6% cases of FHF, SHF and CAH groups, respectively. HBV infection, as indicated by serum positivity of IgM anti-HBc in the FHF and SHF groups and HBsAg and/or IgM anti-HBc in the CAH group, was detected in 19.1%, 23.1% and 69.7% of cases from these three groups, respectively. IgM anti-HDV, demonstrating active/recent HDV infection, was found in 8.1% cases of FHF and 9.2% cases of SHF patients. HDV as a superinfection in HBsAg carriers was noted in 4.5% and 4.6% cases, respectively of FHF and SHF groups. Similarly, HDV-HBV coinfection, diagnosed by simultaneous presence of IgM anti-HBc and IgM anti-HDV in the FHF and SHF groups, was recorded in 3.6% and 4.6% of cases from these two groups, respectively. In the CAH group, HDV infection was observed in 9.2% cases. HDV infection, recorded in less than 10% of patients with different liver diseases in India, seems to be an unimportant factor in inducing severe liver diseases in this country.

Increased frequency of HLA DR13 in hepatitis C virus carriers with persistently normal ALT levels.

The aim of this study was to clarify the relationship between human leukocyte antigen DR allele distribution and the degree of liver cell injury of hepatitis C virus (HCV) carriers in Japan. The subjects, 68 HCV carriers, were divided into two groups according to the laboratory data and liver histology. Those in the asymptomatic carrier group (n = 19) had normal ALT levels persistently for 8-153 months (mean 25.7 months) and were diagnosed histologically as normal liver, nonspecific reactive hepatitis or chronic persistent hepatitis. Those in the chronic active hepatitis group (n = 49) had elevated ALT levels and were diagnosed histologically with chronic active hepatitis. The human leukocyte antigen DR alleles of all subjects were defined using the polymerase chain reaction restriction fragment length polymorphism method. The expression of human leukocyte antigen class I antigen and intercellular adhesion molecule 1 on the hepatocyte membrane were also examined in 14 patients from each group using an indirect immunohistochemical method. The frequency of DR13 (42.1%) in the asymptomatic carrier group was significantly higher (Pc < 0.003) than that of the chronic active hepatitis group (4.1%). There were no significant differences for the other DR alleles. The frequencies of expression of human leukocyte antigen class I antigen and intercellular adhesion molecule 1 on the hepatocyte membrane of the asymptomatic carrier group were significantly less than those of the chronic hepatitis group (64% vs. 100% P < 0.05, 29% vs. 71% P < 0.05, respectively), although there was no significant difference in the serum HCV-RNA titer between the two groups (10(6.4 +/- 1.1) vs. 10(6.5 +/- 0.7) copies/mL). These results demonstrate that the cellular immune response of the asymptomatic carrier group is less activated than the response of the chronic active hepatitis group and that HLA DR13 may be closely associated with this low activity of hepatitis among HCV carriers.

Activities of superoxide dismutase in erythrocyte of nonalcoholic chronic liver diseases

1. 1. Superoxide dismutase (SOD) activity was studied in erythrocyte (RBC) of 42 patients with chronic liver disease. 2. 2. Erythrocyte SOD activities in chronic active hepatitis (CAH) and active liver cirrhosis (ALC) groups were not significantly different from that of the control. 3. 3. Erythrocyte SOD activity in the inactive liver cirrhosis (ILC) group was significantly lower than that of the control. 4. 4. No differences of erythrocyte SOD activity were found between CAH, ALC and ILC groups. 5. 5. The reason underlying this finding is obscure and can probably be related to a decrease in the synthesis of SOD.

Gm and Km phenotype frequencies in children with chronic active hepatitis (CAH) B virus infection.

Patients with CAH, extrahepatic HBV manifestation and healthy children were studied for presence of Gm 1, 2, 3, 10, 21 factors and Km 1 factor. significantly higher frequency of Gm (1, 2, 3, 10, 21) phenotype was shown in CAH group as compared with the other two groups. Relationship between Km factors and examined groups was not found.

Serum laminin in patients with chronic active hepatitis and mild liver diseases

Laminin is a component of the basement membranes synthesized by Ito cells. We have measured the serum levels of laminin in 15 chronic active hepatitis patients and in 29 patients with mild liver diseases, who also underwent a complete clinical and laboratory evaluation. Abnormal levels of laminin were observed in 13.3% of chronic active hepatitis and in 10.3% of mild liver disease patients. Patients with chronic active hepatitis had higher serum levels of laminin than patients with mild liver diseases ( P = 0.016). However, the usefulness of laminin to differentiate between these two groups was limited. Highly significant correlations were found between laminin and total protein ( r = 0.79, P < 0.0001), γ-globulins ( r = 0.78, P < 0.0001), and IgG ( r = 0.73, P = 0.0001) in the chronic active hepatitis group and lower in the mild liver diseases group. A possible role of defective immunoregulation in the increase of laminin is suggested.

Immunological studies in patients with HBsAg-positive chronic active hepatitis--spontaneous lymphocyte transformation and natural killer cell activity.

The present study was to address the nature of cells which are responsible for enhanced spontaneous lymphocyte transformation (SLT) observed in patients with HBsAg-positive chronic active hepatitis (CAH). The subjects consisted of 34 cases with HBsAg-positive CAH (group I), 31 HBsAg carrier (group II), and 27 normal persons (group III) who had no serological evidence of hepatitis B virus (HBV) infection. SLT values and the number of cells bearing HLA-DR antigens in group I (1021.45±276.40 cpm, 36.94±4.90%) were significantly (p<0.01) elevated as compared to group II (103.74±30.44 cpm, 13.26± 4.72%) and III (118.92 ± 30.84 cpm, 14.93±5.10%), but there was no difference of the number of the IL-2 receptor-bearing cells among each groups. Though natural killer (NK) cell activity in both group I (65.42±15.77%) and II (59.14±14.89%) were significantly enhanced as compared to group III (46.25±20.20%), there was no difference in between group I and II. These findings indicate that the cells bearing HLA-DR antigen, but not NK cells, are responsible for the enhanced SLT in patients with CAH.

Measurement of Portal Vascular Resistance in Patients With Portal Hypertension

Portal vascular resistance was measured percutaneously in 60 patients with chronic liver disease and in 5 control subjects. The portal vascular resistance (PVR) was calculated, using the following equation, from the portal blood flow (QPV), portal venous pressure (PPV), and hepatic venous pressure (PHV): PVR = (PPV - PHV)/QPV. The portal blood flow was measured using an ultrasonic Doppler duplex system, and the portal venous and hepatic venous pressures were measured using percutaneous transhepatic catheterization and venous catheterization, respectively. The wedged hepatic venous pressure was measured by occluding the hepatic venous branch using a balloon catheter. The portal vascular resistance was 0.25 +/- 0.13 mmHg X ml-1 X min X kg body weight (mean +/- SD, n = 5) in the control group, 0.64 +/- 0.29 mmHg X ml-1 X min X kg body wt (n = 13) in the chronic active hepatitis group, 1.34 +/- 0.79 mmHg X ml-1 X min X kg body wt (n = 30) in the cirrhosis group, and 0.85 +/- 0.69 mmHg X ml-1 X min X kg body wt (n = 13) in the idiopathic portal hypertension group.

Chronic active hepatitis in alcoholic patients.

The histologic appearances characteristic of chronic active hepatitis (CAH) were observed in liver biopsies of seven patients among whom alcohol abuse was the only identifiable determinant of liver disease. Clinical, hematologic, biochemical and histologic features in these patients were contrasted with those of 20 patients with typical alcoholic hepatitis. For the CAH group, the liver was less enlarged below the costal margin, a palpable spleen was more frequent, the mean neutrophil count was lower, and there was a lower mean level of transaminase enzymes. In both groups there was minimal evidence of the serologic markers of autoimmune CAH or antecedent hepatitis B virus (HBV) infection. Histologically, all liver biopsies in the CAH group showed perilobular "piecemeal" necrosis, "rosette" formation and dense portal and septal lymphoid infiltrates, in contrast to the fatty change, Mallory bodies and intralobular neutrophil clusters of the alcoholic hepatitis group. In the CAH group, a second liver biopsy was assessed after a period during which alcohol consumption was known; histologic improvement or deterioration correlated with abstinence or continuation of drinking. Thus "alcoholic" CAH has some clinical and histologic features distinct from those of typical alcoholic hepatitis, but the two types were similar in other respects including dependence of the course of disease on continuing use of alcohol.

Seroimmunologic classification of chronic hepatitis in 57 children.

A seroimmunologic evaluation of 57 children with chronic hepatitis is presented. Twenty-one patients had chronic persistent hepatitis and 36 had chronic active hepatitis. Serum samples obtained before treatment were tested for HBsAg, anti-HBs, anti-HBc, smooth muscle antibody, and antibody to endoplasmic reticulum. A persistently positive HBsAg was observed in the serum of 18 of the 21 patients with chronic persistent hepatitis. The chronic active hepatitis group was divided into three subgroups according to the presence of hepatitis B-virus markers (7 patients), smooth muscle antibody (10 patients), and endoplasmic reticulum antibody (9 patients). Determination of these markers could be useful for classifying children with chronic hepatitis.