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Interface Hepatitis over Grade 2 May Differentiate Chronic Inflammation Associated with CHB from NAFLD in the Early
Yong-Fen Zhu1, Jin Wang1, Jia-Zhui Fang1
1Department of Hepatology and Infection, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou 310016, China.
Insights
Interface hepatitis over grade 2 is a key indicator for differentiating chronic hepatitis B (CHB) from nonalcoholic fatty liver disease (NAFLD) in early stages. This finding aids in diagnosing co-existing CHB and NAFLD, crucial for effective treatment strategies.
Area of Science:
- Hepatology
- Gastroenterology
- Pathology
Background:
- The co-occurrence of chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent.
- Distinguishing the causes of chronic liver inflammation in these patients is clinically significant.
Purpose of the Study:
- To identify distinct pathological features for differentiating CHB-related inflammation from NAFLD-related inflammation.
- To evaluate the utility of these features in patients with co-existing CHB and NAFLD.
Main Methods:
- Retrospective analysis of liver biopsy data from patients with CHB (n=31), NAFLD (n=50), and CHB-NAFLD (n=51).
- Assessment of chronic inflammation using the METAVIR scoring system, focusing on interface hepatitis and fibrosis.
- Comparative analysis of pathological features across groups, including fibrosis-matched and viral load-stratified analyses.
Main Results:
- Interface hepatitis and fibrosis (grade ≥2) were significantly more prevalent in CHB patients compared to NAFLD patients.
- Even after matching for fibrosis, interface hepatitis (grade ≥2) remained significantly higher in CHB.
- In CHB-NAFLD patients with early fibrosis, higher viral load correlated with increased interface hepatitis.
Conclusions:
- Interface hepatitis over grade 2 serves as a reliable marker for differentiating early-stage chronic inflammation in CHB versus NAFLD.
- This histological feature is valuable for the differential diagnosis in patients with co-existing CHB and NAFLD.
Background:
Patients with chronic hepatitis B (CHB) concomitant with nonalcoholic fatty liver disease (NAFLD) are increasing.
Objectives:
To identify pathological features that can be used to differentiate between chronic inflammation caused by CHB and that caused by NAFLD.
Methods:
Patients with CHB (n = 31) needing antiviral treatment, NAFLD (n = 50), or CHB-NAFLD (n = 51) who underwent biopsy were retrospectively enrolled. Pathological characteristics of chronic inflammation were evaluated using the METAVIR scoring system. The rates of three pathological characteristics were first compared in patients with NAFLD and those with CHB, then compared after fibrosis matching, and were finally compared in CHB-NAFLD patients with different viral loads.
Results:
The rates of interface hepatitis over grade 2 and fibrosis over grade 2 were significantly higher in the CHB group than in the NAFLD group (100% vs. 4% and 80.6% vs. 22%; both P < 0.0001), while no significant difference was observed in the rate of lobular inflammation over grade 2 between the two groups. After fibrosis matching, in patients with F0-2 fibrosis, the rate of interface hepatitis over grade 2 in CHB was significantly higher than that in NAFLD (100% vs. 0%; P < 0.0001). In CHB-NAFLD patients with F0-2 fibrosis, the rate of interface hepatitis over grade 2 in cases with a high viral load was significantly higher than cases with a low viral load (66.6% vs. 0%; P < 0.0001). The rate of lobular inflammation showed no difference between groups.
Conclusion:
Interface hepatitis over grade 2 can be used for the differential diagnosis of chronic inflammation associated with CHB or NAFLD in the early stage.
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