Patients With Unexplained Liver Disease Occult HBV Infection Detection And Clinical Significance

Objective:To analyze the proportion and clinical and pathological features of occult HBV infection in the unknown causes of liver disease in patients.To discuss the prevalence rate about occult HBV infection,its significance in the unknown causes liver damage,its possible routes of transmission,and the development of the liver.To explain its necessity to puncture liver for histologic examination and etiology of diagnosis by immunohistochemistry.Methods:In 36 cases of unknown causes liver disease patients,to examine serum A-E Hepatitis virus markers and other markers of liver virus by enzyme-linked immunosorbent assay(ELISA) or microparticle enzyme immunoassay(MEIA),to detect serum HBV-DNA by fluorescence quantitative PCR of and serum HCV-RNA by RT-PCR.According to the history, abdominal B-Ultrasound,routine tests(such as liver function,blood lipids,Serum ceruloplasmin,blood copper,urinary copper,and other autoantibodies),to exclude autoimmune liver disease,alcoholic liver disease,drug-induced liver disease and metabolic liver disease.In the guiding of ultrasonic machine,to puncture liver of all patients by the ejection of tissue biopsy gun.For the conventional liver tissue biopsy of each patient,to do HE-eosin, multi-perspective observation by optical microscopy for histologic diagnosis.For the conventional liver tissue biopsies of each patient,to detect HBsAg,HBcAg,HCVAg in liver tissue the by the two-step method of immunohistochemistry for etiology diagnosis.HBsAg and (or) HBcAg positive in liver tissue is the evidence of occult HBV infection.To analysis and summary the clinical data.Results:Serum HBsAg,anti-HBs,HBeAg,anti-HBe,anti-HBc,anti-HAV,anti-HCV and anti-HDV,anti-HEV,anti-CMV,anti-EBV,HBV-DNA,HCV-RNA are negative. Anti-nuclear antibody(ANA),anti-smooth muscle antibodies(SMA),anti-liver and kidney microsomal antibodies(LKM-1),anti-soluble liver antigen(SLA) and other autoantibodies were negative,blood Lipids,serum ceruloplasmin,blood copper and urine copper were in the normal range.There are 14 cases with HBsAg and(or) HBcAg positive in liver tissue;10 cases with HBsAg and(or) HBcAg,HCVAg positive;12 cases all negative.The 24 patients of Occult HBV infection,the liver tissues of 8 cases Show mild to moderate chronic hepatitis, inflammation grade for G1-G2,fibrosis stage S0-S3;that of 14 cases perform liver cirrhosis, inflammation grade G3-G4,fibrosis stage S3-S4;that of 2 cases are diagnosed as hepatocellular carcinoma.For the 10 patients of occult HBV and HCV co-infection,inflammation grades are G3-G4;fibrosis stage S3-S4.Hepatic cytosolic HBsAg expression show Uniform type cytoplasm,Cytoplasmic inclusion bodies,no-membrane,diffuse,scattered or colony of distribution;HBcAg expression show mainly cytoplasmic,the nucleus of a minority,with the same distribution as HBsAg;HCVAg expression show cytoplasmic,with the same expression and distribution as HBsAg.24 patients of occult HBV infection have no specific clinical manifestations,mainly as gastrointestinal symptoms and fatigue.Some who developed liver cirrhosis present ascites,gastrointestinal bleeding,hepatosplenomegaly and so on.Some who developed liver cancer present abdominal pain,discomfort.All patients have abnormal liver function.3 patients show the symptoms of liver cirrhosist initially.A patients with blood transfusion is detected HBVAg,which suggests that occult HBV infection may be transmitted through blood transfusion.For the mother of one case with a history of hepatitis B,the serum hepatitis B virus markers are negative now,which suggests that his mother may also exist occult HBV infection and he was infected through vertical transmission.Conclusion:1 Hepatitis virus infection is still the main reason for liver disease of unknown cause, especially HBV infection.Occult HBV infection in this group of unknown causes liver disease accounted for 66.7%(24/36).2 Occult HBV infection is closely linked with Occurrence and development of chronic hepatitis,cirrhosis,liver cancer.3 The clinical features of the patients who exist occult HBV infection:be getting on in age; having no family aggregation mainly;clinical types have hepatitis,cirrhosis,liver cancer or only imaging abnormalities.4 The patients with unknown causes liver disease may occur the co-infection of occult HBV and HCV and the co-infection may increase the liver tissue injury.5 To do immunohistochemical and routine pathological examination for the patients with unexplained liver disease,which have important clinical significance.It is helpful to clear etiological diagnosis,to judge liver lesions,to guide treatment and judge prognosis more accurately.