AI Article Synopsis
- The study analyzed liver biopsies from 40 patients with chronic hepatitis B treated with corticosteroid withdrawal therapy, focusing on long-term liver histology changes.
- Significant improvements were observed in liver histology scores, indicating reduced necroinflammatory and fibrotic activity after treatment, although some inflammatory cells persisted for extended periods.
- Findings suggest that while patients may experience clinical remission, achieving complete histological resolution of liver inflammation can take years, with fibrosis before therapy being a key factor in the healing process.
Article Abstract
Objective: Although biochemical and virological responses to corticosteroid withdrawal therapy for chronic hepatitis B have been extensively studied, long term changes in liver histology have not been well documented.
Methods: We retrospectively analyzed 45 paired liver biopsy specimens taken before and after treatment from 40 patients who persistently showed biochemical remission and an absence of HBe antigen (RIA) for up to 20 yr.
Results: The grading scores for necroinflammatory and fibrotic activity in the liver specimens decreased significantly after corticosteroid withdrawal therapy. Histological scores graded according to Knodell's components improved significantly in every category after corticosteroid withdrawal therapy. However, inflammatory cell infiltrates remained within the liver for long periods. The disappearance rate of necroinflammation in the periportal, lobular, and portal regions of the liver were 25%, 7.4%, and 7.4%, respectively, at yr 5 after therapy, and were 84.4%, 78.2%, and 58.7%, respectively, at yr 10 after therapy. The cumulative disappearance rate, calculated using the Kaplan-Meier method, was significantly lower for portal inflammation than for periportal necroinflammation.
Conclusions: Our results show that: 1) despite clinical remission of chronic hepatitis B virus infection, long periods are needed for histological resolution of necroinflammation in the liver; and 2) by a Cox proportional hazard analysis of the factors contributing to histopathological disappearance of disease-related inflammation, the degree of fibrosis of liver biopsy specimens from pretherapy patients was the most statistically significant factor (p = 0.049).
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| http://dx.doi.org/10.1111/j.1572-0241.1999.01542.x | DOI Listing |
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