The Relationship Between Clinic And Histopathology In Patients With Chronic Hepatitis B Virus And Hepatitis C Virus Coinfection

Objective: To investigate the feature of histopathology in patients with chronic liver disease caused by HBV and/or HCV infection ; To elucidate the feature of interaction between HBV and HCV in patients coinfected with HBV and HCV, and compare with those infected with HBV or HCV alone.Method: samples of liver biopsy and sera of patients with Chronic hepatitis (include Chronic hepatitis B, Chronic hepatitis C , HBV and HCV coinfection and cirrhosis )were collected through needle aspirated and routine tested.2,All Sera samples were detected by routine test(liver function, HBVDNA,HBV marker,HCVRNA,anti-HCV in Sera were detected).3,All liver specimens were fixed in a 4% neutral buffered formalin, embedded in paraffin and stained with hematoxylin- eosin , Masson trichrome. HBSAg and HBCAg were detected by immunohistoche- mical, HBVDNA and HCVRNA were detected by in situ hybridization. And confirmed by in situ polymerase chain reaction(PCR).results: In patients with chronic hepatitis caused by HBV alone, the level of sera HBVDNA are not associated with inflammatory grade and fibrinous stage(P>0.05). 62.5% 0f patients coinfected with HBV and HCV suffered severe hepatitis, while the rates of those infected with HBV or HCV alone were 27.1% and 30.6%, respectively(P<0.01). In patients with severe chronic hepatitis, those coinfected with HBV and HCV have similar or lower level of glutamate pyruvate transaminase,glutamate oxalo-acetate transaminase, total bilirubin and direct bilirubin (ALT,AST,TB and DB )as compared with those infected with HCV(P>0.05) or HBV(p<0.05)alone, respectively. however, there were no significant different changes of sera in patients suffered from non-severe hepatitis. In patients with chronic liver disease caused by HBV or/and HCV, those coinfected with HBV /HCV and infected with HCV alone are older than those infected with HBV alone (p<0.01). those infected with either HBV or HCV have longer duration of morbility than those coinfected with HBV /HCV, and the latter have shorter duration to develop severe hepatitis(p<0.01). In patients coinfected with HBV and HCV, 12.5% were HBVDNA positive and 75% were HCVRNA positive, while 87.7% HBVDNA positive and 80.6% HCVRNA positive in patients infected with HBV or HCV alone, respectively. Conclusions: Levels of sera HBVDNA do not correlate with histological activity in patients infected with HBV alone. Combined chronic hepatitis B and C leads to more severe liver disease. In patients with severe chronic hepatitis, those coinfected with HBV and HCV have similar or lower level of ALT,AST,TB and DB as compared with those infected with HCV or HBV alone, respectively. patients Coinfected with HBV /HCV and infected with HCV alone are older than those infected with HBV alone. those infected with either HBV or HCV have longer duration of morbility than those coinfected with HBV /HCV, and the latter have shorter duration to develop severe hepatitis. In patients coinfected with HBV and HCV, both viruses can inhibit each other simultaneously, and HCV may play a dominant role.