AUTOIMMUNE HEPATITIS: HISTOLOGIC ASSESSMENT BEFORE AND AFTER THE TREATMENT
Jussara Melo de C. Maia; Lauro Virgílio de Sena; Hélcio de S. Maranhão; Maria Célia de C. Formiga; Ana Maria de Oliveira Ramos.
Pediatric Hospital of the Federal University of Rio Grande do Norte - Brazil
INTRODUCTION
Autoimmune Hepatitis (AIH):is
characterized histologically by interface hepatitis, serologically by the presence of non-organ liver specific
autoantibodies and increased levels of immunoglobulin G.
(Czaja, 1984)
{ International Autoimmune Hepatitis Group:
The previous designation
autoimmune chronic active hepatitis was considered inappropriate,
because autoimmune hepatitis is by definition a chronic liver disease.
(Johnson PJ e Mc Farland IG, 1993)
{ The goal of this research was to study histologic findings of AIH in
children before and after the clinical treatment.
MATERIALS AND METHODS
{ Our study population consisted of 10 patients (M:F= 9 : 1), who
satisfied preestablished criteria for AIH, and were enrolled in Pediatric Hepatology Service (Pediatric
Hospital of the Federal University of Rio G. Norte) from 1990 to 2006.
MATERIALS AND METHODS
{ Each patient had had two liver
biopsy: the first performed at time of the diagnosis and the second
after clinical and biochemical
remission, at least 6 months after the start of the treatment.
MATERIALS AND METHODS
{ Hepatitis A,B and C as well others
chronic hepatitis were moved away.
{ Auto-antibodies searched:
Smooth-muscle antibodies (SMA), Antinuclear antibodies (ANA)
Antibodies to liver/kidney
microsome type 1 (anti-LKM1)
MATERIALS AND METHODS
{ AIH type 1: seropositive for ANA and/or SMA.
{ AIH type 2: seropositivity for anti- LKM 1.
{ Clinical form at presentation:
Acute form – disease duration of less than 1 month
Chronic form-clinical disease of at least 6 months duration.
(Sherlock S. 1974)
Histologic Assessment
{ Carried throught colorations:
Hematoxylin/eosin,Masson trichrome, reticulin, PAS with diastase, Perls and Calleja.
{ Evaluated parameters: Inflammatory activity and the degree of fibrosis
(National Consensus of the Brazilian Society of Pathology – 2000)
STATISTICAL ANALYSIS
{ To compare the results of the biopsies, the non - parametric Wilcoxon test was applied.
Differences were considered
statistically significant if p<0.05.
RESULTS
{ Mean and median age at time of the diagnosis: 8,4 ± 3,2 years and 8,7
years (3,4 -13).
{ All patients had at presentation AIH type 1 and chronic form.
{ Mean interval between the start of the treatment and biochemical
remission : 6,6 months.
{ Mean interval between the hepatic biopsies before and after the
treatment: 27 months.
TABLE 1: Laboratory findings of 10 children with Autoimmune Hepatitis
Patient 1 2 3 4 5 6 7 8 9 10 Median
ALT 107 1820 309 660 523 660 1159 725 1140 1620 692,5
AST 186 2365 91 490 1140 1560 1840 520 1250 1287 1195
BT 5,93 4,00 1,71 20,60 23,73 5,45 11,00 4,52 3,94 14,50 12,8 BD 4,21 2,70 1,00 17,40 17,88 4,20 9,90 2,45 2,63 14,00 12,0 GG 1,17 1,93 1,52 2,88 3,57 2,39 2,36 2,34 3,57 2,33 2,4
ANA 80 80 160 160 0 160 80 80 0 640 -
SMA 0 640 0 40 80 0 0 0 160 640 -
FIGURE 1 - Histologic findings of hepatic inflammatory activity before and after the treatment of 10 children with auto-immune hepatitis based in the National Consensus of the Brazilian Society of Pathology – 1999.
Periportal Activity Lobular Activity Portal Inflammation Befo
re AFTER BEFOR
E AFTER BEFORE AFTER
1 3 0 1 1 2 1
2 4 1 3 1 3 3
3 2 0 1 0 2 0
4 4 2 3 1 3 2
5 3 1 3 0 2 2
6 4 1 2 1 3 2
7 3 2 4 1 4 1
8 3 2 1 1 2 2
9 3 3 3 3 2 2
10 2 2 2 1 2 1
PATIENT
Wilcoxon Test p = 0,011 p= 0,027 p = 0,043
FIGURE 2: Degrees of fibrosis in hepatic biopsies before and after the treatment of 10 children with auto-immune hepatitis based in the National Consensus of the Brazilian Society of Pathology – 2000.
DEGREES OF FIBROSIS PATIENT
BEFORE AFTER
1 2 2
2 3 3
3 4 2
4 2 2
5 2 2
6 3 2
7 3 1
8 3 3
9 3 3
10 1 2
Wilcoxon Test p = 0,201
CONCLUSION
{ The data showed significant reduction of the inflammatory
activity of the hepatitis, but not of the degree of fibrosis.
REFERENCES
{ CZAJA AJ. Natural history, clinical features, and treatment of autoimmune hepatitis,
Semim Liner Dis 1984; 4:1-12.
{ Johnson PJ, McFarland IG. Meeting report:
International Autoimmune Hepatitis Group.
Hepatology 1993; 18: 998-1005
{ Sherlock S. Chromic Hepatitis – Gut 1974;
15: 581 – 97
{ Gayotto LCC Visão Histórica e Consenso
Nacional sobre a Classificação das Hepatites Crônicas – GED – 2000; 19: 137-140
