甲型肝炎病毒诱发的儿童自身免疫性肝炎的临床病理学特征

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Samannay Das, Vikrant Sood, Archana Rastogi, Neha Agarwal, Sanjeevani Kaul, Deepika Yadav, Bikrant Bihari Lal, Rajeev Khanna, Seema Alam
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引用次数: 0

摘要

有有限的证据表明,甲型肝炎病毒(HAV)感染可诱发肝脏自身免疫,但这一领域在很大程度上仍未得到探索。因此,本研究计划将 HAV 引起的自身免疫性肝炎(HAV-ALH)与 HAV 相关肝功能异常(HAV-急性病毒性肝炎或 HAV-AVH)和传统自身免疫性肝炎(AIH)进行比较。这是一项回顾性研究,研究人员对 46 例接受肝活检的 HAV 感染患者(包括 17 例 HAV-ALH:根据组织病理学诊断)与 46 例年龄和性别匹配的典型 AIH 患者进行了比较。总体而言,HAV组(n = 46)的瘙痒发生率更高、胆红素水平更高、胆汁淤积比例更高、IgG水平更低、血清阴性更高且无疾病复发,而经典型AIH组的界面性肝炎、纤维化、坏死和假性硬化的比例/严重程度更高(P<0.05)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinico-Pathological Spectrum of Hepatitis A Virus-Induced Autoimmune-Like Hepatitis in Children.

There is limited evidence that hepatitis A virus (HAV) infection can trigger hepatic autoimmunity, but this area remains largely unexplored. This study was thus planned with the aim to compare HAV-induced autoimmune-like hepatitis (HAV-ALH) with HAV-related liver dysfunction (HAV-acute viral hepatitis or HAV-AVH) and classical autoimmune hepatitis (AIH). This was a retrospective review of 46 patients with HAV infection who underwent liver biopsy (including 17 cases of HAV-ALH: diagnosis based on histopathology), and they were compared to 46 cases of age- and gender-matched classical AIH. Overall, HAV cohort (n = 46) had higher prevalence of pruritus, higher bilirubin levels, higher proportion of cholestasis, lower IgG levels, higher seronegativity and lack of disease recurrence, while the classical AIH group had higher proportion/severity of interface hepatitis, fibrosis, necrosis and pseudorosetting (p < 0.05). In comparison to the classical HAV-AVH group, HAV-ALH group had higher AST levels, higher presence of autoantibodies, and higher prevalence of severe zone 3 perivenulitis and marked pseudorosetting on histology (p < 0.05). Also, HAV-ALH group, in comparison to the AIH group, had more pruritus (OR 7.29, p < 0.004) and more seronegativity (41% vs. 13%, p < 0.031), while duration of illness (p < 0.003), IgG (p < 0.001) levels and liver stiffness measurement (p < 0.006) were significantly higher in AIH group (versus the HAV-ALH and HAV-AVH groups). Histologically, in comparison to AIH, HAV-ALH group had significantly less interface hepatitis (OR 0.03, p < 0.001) and fibrosis (OR 0.08, p < 0.001) and significantly more cholestasis (OR 4.5, p < 0.021). HAV infection can act as a potential trigger for immune-mediated hepatic damage, akin to drug-induced autoimmune-like hepatitis. Larger multicentric studies are needed to further explore this aspect.

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来源期刊
Journal of Viral Hepatitis
Journal of Viral Hepatitis 医学-病毒学
CiteScore
6.00
自引率
8.00%
发文量
138
审稿时长
1.5 months
期刊介绍: The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.
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