Hepatitis Of Different Etiology Research Articles

Changes in the expression of oxidative stress genes in toxic hepatitis of different etiologies and their correction

The study aims to study of changes in transcriptional activity of oxidative stress genes in acute toxic hepatitis. Materials and methods. The study material was white mongrel male rats weighing 180-200 grams. The studied toxicants were: carbon tetrachloride, ethanol, acetaminophen. As hepatoprotectors were introduced: oxymethyluracil, ademethionine and ethylmethylhydroxypyridine succinate. RNA was isolated, which was subjected to reverse transcription. RT-PCR was performed using a real-time PCR system in the presence of SYBR Green. GAPDH was used as a normalized control. The expression of the studied genes was evaluated by PCR analysis using pre-selected primers. Statistical significance was checked using IBM SPSS Statistics software. Results. In comparison of experimental groups, statistically significant differences were found in the level of expression of the CASP7 gene. Transcriptional activity of the CHEK gene (k=11.25; p=0.024). The GCLC gene (k=21.70; p=0.001) reached its minimum value of -3.6 [-3.72; -3.32] in the Mexidol group. The multiplicity of expression of the GSTM1 gene (k=15.54; p=0.004) had the highest value -0.14 [-1.11; 1] in the group that did not receive TCM. The NQO1 gene achieved its statistical significance in a 72-hour experiment (p=0.005). Statistical analysis of the RIPK gene showed significant differences. The expression level of the GSTP1 gene (k=10.39; p=0.034) reached its maximum value in the untreated group of 0.03 [-0.74; 0.48]. Expression of the NFE2L2 gene with acetaminophen administration showed the following results (k=13.64; p=0.009). Glutathione activity (k=10.29; p=0.036) reached its minimum value in the group receiving Mexidol -1.6 [-1.7; -1.29]. The multiplicity of superoxide dismutase expression showed statistical significance (p=0.003). Conclusions. Markers of the clinical course, prognosis and outcomes of toxic hepatitis were found. These data make it possible to determine the severity of the disease at the stage of early molecular response, when active clinical symptoms have not yet developed, which makes it possible to prescribe targeted therapy and adjust treatment tactics.

Effects of triterpenoids in fatty products on liver condition of laboratory animals with acute toxic hepatitis

One of the principles of prevention and non-medicamentous treatment of liver diseases, including hepatitis of different etiology, is the normalization of the diet through the consumption of food with physiologically active ingredients, in particular betulin, which helps to eliminate the causes of metabolic and oxidative disorders within liver cells. The aim of the research was to assess in vivo the influence of triterpene alcohol betulin extracted from Betula pendula Roth. birch bark in fat-containing products (for example mayonnaise) on the blood biochemical parameters and liver morphological structure of rats with initiated acute toxic hepatitis. Material and methods. Hepatoprotective and antioxidant activities of betulin as part of mayonnaise samples has been investigated in vivo on the model of toxic hepatitis initiated by carbon tetrachloride in male Wistar rats weighing 210-265 g. The animals were divided into 4 groups of 10 animals each: CG-1 - intact, CG-2 and MG - with carbon tetrachloride initiated toxic hepatitis. rats of the main groups were orally administered mayonnaise once a day at a dosage of 1 ml for 21 days after the formation of the model pathology: OG-1 with the added betulin (1 mg per 1 kg of body weight), OG-2 without betulin. Disorders of metabolic and oxidative processes in liver cells of animals were evaluated by biochemical indicators of blood plasma: the level of glucose, albumin, total cholesterol, triglycerides and urea and the activity of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and γ-glutamyltransferase. Oxidative stress in rats was estimated by the activity of catalase and superoxide dismutase in blood hemolysate (at a dilution of 1:200 and 1:10, respectively); the total prooxidant (in blood plasma) and total antioxidant (in blood hemolysate at a dilution of 1:10) activity were determined spectrophotometrically (colored complexes of TWIN-80 oxidation products with thiobarbituric acid). The morphological structure of rats' liver was estimated by microscopy of prepared cuts of hepatic tissue. Results. Based on biochemical parameters of rat blood plasma, it has been established that the administration of mayonnaise with betulin prevents the development of cytolic syndrome and suppresses the process of peroxidation by directly neutralizing free radicals. Aspartate aminotransferase and alkaline phosphatase activity in blood plasma of the experimental animals of the main group MG-1 reduced by 20.7 and 35.2% compared with indicators of the rats of the main group MG-2. Glucose concentration normalized to the level of the control group CG-1. The concentration of bilirubin and triglycerides decreased by 22.9 and by 48.1%, which indicates a significant reduction in the indicators of cholestatic syndrome in the group of animals OG-1 compared to OG-2. The total prooxidant activity and the concentration of thiobarbiturate-reactive products decreased compared to the CG-2 and MG-2 groups, which indicates the suppression of oxidative stress and, as a result, an improvement in liver conditions of animals with toxic hepatitis even when taking a fat-containing product. In liver histopeparates of animals receiving mayonnaise with betulin, necrobotic changes were less pronounced in comparison with the group MG-2. They were estimated at 1 point: small-drip dystrophy spots were found, haemorrhages in the interregional septum with inflammatory infiltration in the course of hemorrhages against the presence of necrosis hepatocytes with pronounced adipose dystrophy in the centres of the lobules, step necrosis with signs of replacing the damaged hepatocytes of the connective tissue, accompanied by centrolobular hemorrhages in MG-2 rats. Conclusion. Introduced into the composition of mayonnaise betulin, reduces the development of cytolic syndrome in toxic hepatitis and suppresses the process of peroxidation, on the basis of which fat-containing foods with betulin can be recommended for clinical examination as specialized products in acute and chronic liver diseases, including complicated cholestasis.

The role of quercetin in the treatment of liver diseases: the review based on experimental and clinical investigations

Scientific review covers current data regarding the role of quercetin in the therapeutic corrections of various liver diseases, in particular non-alcoholic fatty liver disease, chronic hepatitis, drug-induced liver disease. The aim of the review was to sum up current scientific data regarding quercetin properties, its mechanism of action and possibilities of this flavonoid in the treatment of various liver diseases.Conclusions. Quercetin is found to possess antioxidant, anti-inflammatory, hypolipidemic, antisteatotic and antifibrotic properties. The abovementioned makes this flavonoid potentially useful in the treatment of various liver disease, in particular non-alcoholic fatty liver disease, chronic hepatitis of different etiologies, and drug induced liver disease.

Features of reparative regeneration of the liver tissue in rats during experimental tetrachloromethanic and alcoholic hepatitis

Chronic hepatitises are common pathology of the liver, which often end with the formation of cirrhosis (LC). Aim. The features of reparative regeneration of liver tissue, as well as pathomorphosis of chronic toxic hepatitis of different etiology, namely tetrachloromethanic (CTH) and alcoholic (CAH), were studied in the experiment in immature rats. Methods and results. The results of flow cytometric and morphological studies have shown that in rats with CTH significant impairment of lymph flow develops in the form of edema in liver tissue; the number of functioning lymphatic vessels with the presence of lymphangiectasias increases that can significantly influence the processes of fibrogenesis. In rats with CAH fatty liver combined with hydropic one is observed. It was established that a characteristic feature of hepatocytes population of immature rats in CTH is increase of nuclear DNA ploidy>8c, reducing of the percentage of nuclei in the range G 0 G 1 with increasing percentage of cell nuclei in the S-phase, nuclear DNA fragmentation and proliferation index. In CAH, unlike CTH, there was a decrease of synthetic processes in the nuclei of hepatocytes, and polyploidy of nuclear DNA was not observed. Conclusion. This demonstrates the antiproliferative effect of ethanol.

Supersonic Shear Imaging and Transient Elastography With the XL Probe Accurately Detect Fibrosis in Overweight or Obese Patients With Chronic Liver Disease

Assessment of the severity of liver fibrosis is an important step in evaluating patients with chronic liver disease and determining their prognosis. We compared liver stiffness measurements (LSMs) made by supersonic shear imaging (SSI) with those of transient elastography (TE)-XL for their ability to determine the degree of liver fibrosis in overweight or obese patients with chronic liver disease. We performed a prospective study of 258 patients with chronic hepatitis of different etiologies and a body mass index greater than 25, evaluated at the University of Miami from October 2013 to December 2014. Liver stiffness was measured using the TE-XL probe and SSI of the right and left lobes during the same clinic visit, and comparisons were made for fibrosis stage in 124 biopsy-proven patients. In addition, further analysis was performed on a subgroup of 102 chronic hepatitis C virus (HCV)-positive patients for whom biopsy data were available. Reliable LSMs were obtained from 96.1%, 94.6%, and 72.1% of patients using the TE-XL probe, SSI of the right lobe, and SSI of the left lobe, respectively. TE-XL, SSI of the right lobe, and SSI of the left lobe detected severe fibrosis (fibrosis stages 3-4), with area under the receiver operating characteristic curve (AUROC) values of 0.955, 0.954, and 0.910, respectively, compared with results from histologic analysis for the 124 biopsy-proven patients included in the study; these values were 0.952, 0.949, and 0.917, respectively, for the 102 biopsy-proven patients with HCV infection. TE-XL, SSI of the right lobe, and SSI of the left lobe detected fibrosis stage 4 with AUROC values of 0.920, 0.930, and 0.910, respectively, compared with histologic analysis, in all 124-biopsy proven patients, and with AUROC values of 0.907, 0.914, and 0.887, respectively, in the 102 biopsy-proven patients with chronic HCV infection. SSI and the TE-XL probe each accurately quantify liver fibrosis in overweight or obese patients with chronic liver disease, including those with HCV infection, when compared with data obtained from histologic analysis. SSI data obtained from the right lobe and the TE-XL probe can be used to evaluate fibrosis with similar accuracy.

DYNAMICS OF CLINICAL AND BIOCHEMICAL PARAMETERS AND FUNCTIONAL STATE OF THE AUTONOMIC NERVOUS SYSTEM IN PATIENTS WITH ACUTE HEPATITIS B WITH CHRONIC ALCOHOL USE IN HEPATOTOXIC DOSES

Relevance of hepatitis B due to the high incidence complexity of pathogenesis, ineffective treatment, severe consequences of the disease. Among combined lesions of the liver, special attention is paid to viral-alcoholic type. One of the mechanisms of chronic hepatitis of different etiology is violation of the functional activity of the autonomic nervous system. The aim of this work - to determine the dynamics of spectral indices of heart rate variability in patients with acute hepatitis B from chronic use of alcohol in hepatotoxic doses. Materials and methods . 133 patients with acute hepatitis B were under observation. Patients were divided into groups taking account the presence or absence of chronic use of alcohol in hepatotoxic doses and using the classification of alcohol consumption based on the frequency and dose of consumed alcohol. I group comprised 52 patients with chronic use of alcohol in the hepatotoxic doses, II group consisted of 81 patient without this factor. Heart rate variability was diagnosed using computer cardiointervalometry performed by electrocardiographic diagnostic system CardioLab-2000. 20 healthy individuals were in the control group. Results and discussion . Prodromal period in patients of the I group was longer (p 0,05). However, only patients in group I had marked hemorrhagic manifestations (5,8 %) and itching (7.7%). Average serum total bilirubin level was higher (p<0,05) in patients from the I group than in patients from II group. Functional state of autonomic nervous system in patients of both groups were decreased in acute period (vagotonia). Period of convalescence in patients from the I group was accompanied by more severe autonomic dysfunction in 33,6 % (p<0,05). Conclusions. 1. Acute hepatitis B in patients with chronic alcohol use in hepatotoxic doses is characterized by longer (p<0,05) prodrome, cholestatic (7,7%) and hemorrhagic manifestations (5,8%), higher levels of hyperbilirubinemia (p<0,05), and during convalescence maintaining higher (p<0,05), alanine aminotransferase activity compared with group II patients. 2. Acute period of acute hepatitis B regardless of whether chronic alcohol use in hepatotoxic doses is characterized by the development of autonomic imbalance towards vagotonia. 3. Period of convalescence in patients with acute hepatitis B with chronic alcohol use in hepatotoxic doses is accompanied by more severe autonomic dysfunction in 33,6% (p<0,05).

Non invasive tools for the diagnosis of liver cirrhosis.

Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.

Liver distribution of γδ‐T‐cells in patients with chronic hepatitis of different etiology

The gammadelta T cells represent a minor unique T-cell subpopulation long been considered as innate-like immune cells. They are found in increased numbers in tissues from various inflammatory conditions. Their role in chronic hepatitis, however, is still discussed controversially. Fresh frozen tissues from 50 patients (18 cases hepatitis B infection, 25 hepatitis C, three cases with co-infection of hepatitis B and C and four patients with autoimmune hepatitis) were investigated. Immunohistochemistry with primary antibodies detecting alphabeta and gammadelta TCR was used to evaluate their incidence and distribution in the different histological structures of the liver. The inflammatory infiltrate in all cases of chronic hepatitis was dominated by alphabeta T cells and was mainly localized in the portal tracts with formation of an interface hepatitis (95.3%alphabeta T cells; 4.7%gammadelta T cells). There were neither significant differences between inflammatory infiltrate nor the amount or percentage of gammadelta T cells between hepatitis B, C or autoimmune hepatitis. No accumulation of gammadelta T cells could be observed in cases of chronic hepatitis of different etiologies. The immune-mediated phenomena in chronic hepatitis are dominated by alphabeta T cells. Thus, the adapted immune system is responsible for the inflammatory processes in chronic hepatitis.

TT virus detection in oral lichen planus lesions.

Epidemiological studies have demonstrated a correlation between oral lichen planus and different liver diseases. The new virus termed TT virus (TTV) is highly prevalent in patients with chronic hepatitis of different etiology and it may be speculated that TT virus may be involved in the pathogenesis of oral lichen planus. This study examined the presence of TT virus DNA in serum by PCR and in oral mucosa biopsies by in situ hybridization from 20 patients with oral lichen planus (13 with chronic hepatitis and seven without liver disease). Serum and oral mucosa biopsies from six patients all with chronic hepatitis with leukoplakia were also studied as controls. TT virus DNA was positive in the serum of 17/20 (85%) of the patients with oral lichen planus and in all the controls. TT virus DNA hybridization signals were detected in mucosa biopsies from all the patients with TT virus DNA in serum but in none of the three cases without this marker. The percentage of positive cells ranged from 1.6-80%. No differences were found in the percentage of positive cells between TT virus positive patients with and without oral lichen planus and there was no relationship between the number of positive cells and the intensity of the inflammatory infiltrate. In conclusion, TT virus infects oral epithelial cells but the results do not support a role for TT virus in causing oral lichen planus.

Complement System Is Not Activated in Primary Biliary Cirrhosis

There is controversial evidence suggesting that the classical pathway of complement system is chronically activated in primary biliary cirrhosis (PBC) and that complement activation may be important in development of bile duct injury. We have reevaluated this issue by measuring by-products of complement activation such as C4a, C3a, Bb, and terminal complement complexes (SC5b-9) in plasma of 44 PBC patients with sensitive methods not previously used to detect complement activation in this disease. Age-matched healthy women and patients with chronic hepatitis of different etiology were studied as controls. We found that PBC patients have normal C4a concentrations. This finding argues strongly against chronic classical pathway activation. Although a minor increase of C3a levels was observed in a minority of PBC patients, the C3a/C3 ratio, an index used to evaluate the extent of native protein conversion, was remarkably similar in all groups. Potentially lytic terminal complement complexes were not increased. PBC patients had normal Bb plasma levels, indicating that the alternative pathway is also not activated. C3 concentration was higher in PBC patients than in healthy subjects and in chronic hepatitis patients, particularly in the early stages of the disease. C3 and C4 concentrations became lower in PBC and chronic hepatitis with the progression of the disease. The increase of C3 concentration in PBC does not reflect liver inflammation, since serum levels of C-reactive protein are normal. We found high serum C3 levels in patients with rare chronic cholestatic syndromes without superimposed infections and observed that serum C3 levels paralleled those of bilirubin in a patient with benign recurrent intrahepatic cholestasis. In conclusion, our data indicate that complement is not activated in PBC and that the increase of serum C3 levels is related to cholestasis.

HGV/GBV-C infection in patients with acute hepatitis of different etiology and in patients with chronic hepatitis C.

To investigate the prevalence of hepatitis G virus (HGV/GBV-C) in patients with liver disease and to confirm its hypothesized ability to cause liver damage, we studied 130 subjects; 61 had chronic hepatitis C virus infection and 69 had acute hepatitis of either defined etiology (n = 57) or of unknown origin (n = 12). Positivity for HGV/GBV-C RNA was detected in 10 of the 61 subjects with chronic hepatitis C (16.3%) and in 11 of the 57 subjects with acute hepatitis of defined etiology (19%), whereas we failed to detect HGV/ GBV-C viremia in subjects with hepatitis of nonestablished etiology. Patients exhibiting positivity for HGV/GBV-C RNA were found to be comparable to those exhibiting negativity for HGV/GBV-C RNA in terms of both liver function tests and Knodell's score (in liver biopsies); the affect of HGV/GBV-C infection on the biohumoral and histological activity in patients with chronic hepatitis C therefore appears to be minimal or absent. Similar clinical features were observed in patients with acute hepatitis of known etiology whether they were positive or negative for HGV/GBV-C RNA. However, long-term clinical studies are still required to clarify the actual impact of HGV/GBV-C co-infection. In our geographic, i.e., a region or north-east Italy, HGV/GBV-C infection appears to be strictly related to intravenous drug use, and this agent does not seem to be responsible for acute hepatitis of unknown etiology; other etiological agents are probably involved.

Quantitative analysis of glycogen content in hepatocytes of portal and central lobule zones of normal human liver and in patients with chronic hepatitis of different etiology

Glycogen content was determined in hepatocytes of different lobule zones of the normal human liver (23 patients without any liver pathology) and the liver of patients with chronic viral B hepatitis (30 patients) and chronic alcohol hepatitis (28 patients). All the patients were males and aged between 17–50 years. Quantitative analysis of the glycogen content in hepatocytes of portal and central lobule zones was carried out in sections of the human liver (material of punctional biopsies) stained with PAS-reaction. The measurements were carried out using an image analyser ‘Magiscan’ which allows combined cytophotometric analysis of a substance in cells and determination of the cell localization in tissue. The results showed significant differences of the glycogen content in different lobule zones in the normal liver and in the liver in chronic viral and alcohol hepatitis. Ratios of glycogen content in hepatocytes of the portal and the central zones of liver lobule were 1.128 ± 0.004 and 1.061 ± 0.003 in normal human liver, and liver of patients with chronic viral hepatitis respectively, i.e. the glycogen content in hepatocytes of the portal lobule zone was much higher than in the central lobule zone in the normal liver and in the liver of patients with chronic viral B hepatitis. The ratio in patients with chronic alcohol hepatitis was less than 1.0 (0.930 ± .0.003), i.e. a significantly higher glycogen content was found in hepatocytes of the central liver lobule zone. Possible mechanisms of this phenomenon are discussed. Thus, the pattern of the glycogen content in hepatocytes of different lobule zones can be used as an indicator of etiology of chronic hepatitis.

Primary biliary cirrhosis is associated with specific changes in liver IgG-bearing cell subpopulations

Background/Aims: The density of total IgG-bearing cells and the distribution of their subclasses were studied in the liver of patients with primary biliary cirrhosis. Methods: Immunohistochemistry and computerized image analysis were used to compare liver specimens from 18 patients with primary biliary cirrhosis and 28 with chronic hepatitis of different etiology. Results: The density of total IgG-bearing cells was similar in the two groups. However, in patients with primary biliary cirrhosis the proportion of IgG3-positive cells was significantly higher than in patients with chronic hepatitis (53±7% vs. 7.5±2.4%) ( p<10 −8). Conversely, IgG1-positive cells were significantly less prevalent in patients with primary biliary cirrhosis than in chronic hepatitis patients (27±6.9% vs. 68±7.2%, p<10 −8). Stratification of patients with primary biliary cirrhosis according to histology did not show any difference in the distribution of IgG subclasses associated with the progression of disease. Conclusion: These data suggest a pathogenetic role of local IgG3-bearing cells in primary biliary cirrhosis.

Phenotypical analysis and cytokine release of liver-infiltrating and peripheral blood T lymphocytes from patients with chronic hepatitis of different etiology.

Cytokines released by infiltrating T cells may contribute to the hepatic injury in chronic hepatitis. Therefore, we characterized peripheral blood- and liver-infiltrating T cells from patients with chronic hepatitis of different etiology and determined the T cell phenotypes and the cytokine release. Liver tissue and peripheral blood-derived T cells from patients with autoimmune hepatitis and primary biliary cirrhosis predominantly expressed CD4-molecules and the alpha- and beta-chains of the T cell receptor (TCR). In chronic viral hepatitis B and C, liver- and blood-derived T cells were preferentially CD8+ T cells expressing the alpha beta TCR. Mitogenic stimulation with irradiated Daudi lymphoma cells and phytohemagglutinin led to a strong release of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) by T cells in patients with chronic hepatitis and in healthy controls. T cells from patients with primary biliary cirrhosis and some patients with autoimmune hepatitis showed a significantly higher secretion of interleukin-4 (IL-4) and interleukin-10 (IL-10) than T cells from patients with chronic viral hepatitis or healthy controls. Histologic inflammatory activity did not correlate with the amount of cytokines released after mitogenic activation. In conclusion, liver tissue and peripheral blood T cells of patients with autoimmune hepatitis and primary biliary cirrhosis were dominated by CD4+ TCR alpha beta+ T helper/inducer cells, whereas in chronic viral hepatitis an enrichment of CD8+ TCR alpha beta + cytotoxic/suppressor T cells was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum levels of soluble interleukin-2 receptors in acute and chronic viral hepatitis

To analyze interleukin-2-dependent immunoregulatory function in hepatitis B virus infection and in other forms of viral hepatitis, levels of soluble interleukin-2 receptors (sIL-2R) were measured by an enzyme-linked assay in sera from patients with acute and chronic viral hepatitis of different etiology. Increased sIL-2R levels were detected in the early phase of acute hepatitis type A and type B, but not during acute non-A, non-B hepatitis. Among 46 patients with chronic hepatitis B virus infection, levels of sIL-2R were significantly increased only in cases with chronic active hepatitis, while they were about normal in chronic persistent hepatitis or in healthy carriers of the infection. These differences were independent of virus replication, being maintained when patients were stratified according to HBeAg/anti-HBe status and to serum HBV-DNA. Nine patients with chronic active hepatitis type B and high sIL-2R levels at presentation were followed prospectively for two to eight years, and in HBeAg-positive patients, the behavior of receptor levels closely paralleled disease activity. These results, which may reflect increased shedding of IL-2R by activated T lymphocytes in patients with active destruction of HBV infected hepatocytes, indicate the usefulness and potential prognostic importance of serum sIL-2R determination in patients with chronic viral hepatitis. Patients with chronic non-A, non-B hepatitis had much lower sIL-2R levels, although their liver disease was similar to hepatitis B cases, suggesting that different pathogenetic mechanisms operate in these patients.

Mild Pancreatic Damage in Acute Viral Hepatitis

Whether and to what extent the pancreas is involved in acute viral hepatitis is still unclear. In order to address this issue we evaluated serum and urinary amylase and isoamylase levels in 92 patients with acute viral hepatitis of different etiology and in 60 healthy volunteers. Furthermore, pancreatic structure and volume were evaluated by ultrasound scanning. Significant increase in serum and urinary pancreatic isoamylases was found in 12 and 35% of patients, respectively, in the early stage of the disease. Increase in serum pancreatic isoamylases was found only in patients suffering from B and non-A, non-B hepatitis. Ultrasonographic evaluation did not show any change in pancreatic structure and volume. In conclusion, this study suggests that mild pancreatic damage may occur during viral hepatitis.

The significance of IgM antibodies to hepatitis B core antigen in hepatitis B carriers and hepatitis B-associated chronic liver disease.

IgM antibody to hepatitis B core antigen (IgM anti-HBc) was determined in 60 patients whose serum was positive for hepatitis B surface antigen (HBsAg) and 18 patients whose serum was negative for HBsAg, but positive for antibody to hepatitis B core antigen (anti-HBc). Two radioimmunoassays were done utilizing either anti-u antibody to capture IgM or Staphylococcus A protein to separate IgG and IgM. Both methods failed to detect IgM anti-HBc in 30 healthy carriers, 5 HBsAg-positive cirrhotics, 2 patients with HBsAg-positive hepatocellular carcinoma, and 18 HBsAg-negative anti-HBc-positive patients. IgM anti-HBc was present in all 4 patients with acute hepatitis B and in 4 of 8 patients with HBsAg-positive chronic active hepatitis. In patients with chronic active hepatitis, IgM anti-HBc was positive in those with the most intense infiltrate of mononuclear cells on liver biopsy. There was no correlation with the presence of hepatitis B e antigen or anti-HBe. Three of 11 patients with HBsAg-positive chronic persistent hepatitis were intermittently positive by the Staphylococcus A method but all were negative by the u-capture method when a low sensitivity cutoff was employed. The sensitivity of the test can be adjusted at will by the manufacturers and, therefore, introduction of interchangeable controls and standards will enable clinical application of this testing system with meaningful results. Testing for IgM anti-HBc may help the clinician in differentiating healthy HBsAg carriers from patients with HBsAg-positive acute and chronic hepatitis. It is also of value in differentiating patients with acute hepatitis B from HBsAg carriers who develop acute hepatitis of different etiology. Accumulation of more data and correlations with the intensity and nature of the mononuclear infiltrates in chronic hepatitis will increase understanding of the mechanism of switchover from IgM to IgG anti-HBc response and factors favoring chronicity in hepatitis B.