Chronic Hepatitis Etiology
by Jau-Shin WU, M.D.
†HBV, HCV, HDV, Drug, Toxin, Autoimmune, Cryptogenic
†Prevalence: different depends on geographical region, ethnic back ground,
high risk behavior.
†Etiological viruses can be identified by serological tests.
†1. HBV:
†Serum tests for HBsAg, HBeAg, HBV-DNA and histological verification of
HBcAg.
†Serum HBsAg, HBeAg, HBV-DNA (+)¡Gpersisting replication of viruses
.
†Serum HBeAg, HBV-DNA (-) with anti-HBe (+)¡Gusually present with
milder clinical symptoms with less viruses --- usually seen in asymptomatic
carrier.
†HBV variant (precore or HBeAg negative mutant) --- Failure to produce
HBeAg, but with persistent anti-HBe and HBV-DNA --- persistent
progression of hepatic inflammation.
†2. HCV:
†Serum anti-HCV and HCV-RNA (+) --- histological activity is related to
degree of viral replication.
†In some cases, there are production of autoantibodies such as: ANA, anti-LKM
(anti-liver and kidney microsomes).
†3. HDV:
†Serum anti-HDV and HDV-RNA (+)
†Serum HBsAg: usually (+)
†4. Autoimmune:
†Patients losing immunological tolerance of liver itself.
†Various factors as: Genvironment, varied contageous agents trigger the
disease.
†Female predominance.
†Serum hypergammaglobulinemia: more predominant.
†HLA Type: predominantly B8, DR3, DR4
†Frequently associated with autoimmune diseases such as: thyroiditis, ulcerative
colitis, Sjogren's syndrome.
†With chracteristic serum autoimmune antibodies such as: ANA, Anti-LKM
antibody, anti-smooth muscle antobody, anti-soluble liver antigen antibody,anti-liver-pancreas
antigen antibody, anti-asialoglycoprotein receptor antibody, anti-heptocyte
plasma membrane antigen antibody.
†Absence of serum markers of HBV, HCV and HDV infections and anti-mitochrondrial
antibody.
†Well respond to corticosteroid and/or immunosuppressive therapy.
†Subgroups of autoimmune hepatitis:
†Autoimmune hepatitis type 1: high titers of ANA or SMA.
†Autoimmune hepatitis type 2: presence of anti-LKM-1 directed against cytochrome
P-450 IID6.
†Autoimmune hepatitis type 3: presence of soluble liver antigen antobodies
in the absence of ANA or anti-LKM.
†5. Drug-induced chronic hepatitis:
†drugs as a cause of liver injury.
†6. Cryptogenic chronic hepatitis:
†Without evidence of viral, drug-induced or autoimmune induced liver injuries.
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