Chronic hepatitis B: diagnosis

Laboratory Tests

Only bilirubin, y-globulin levels and serum ASA activity are moderately elevated. The serum albumin content is often normal. At the time of treatment, signs of hepatic-cell damage are usually insignificant.

In the case of antibodies to smooth muscles, their titre is low. Antimitochondrial antibodies in serum are absent.

The test for HBsAg is positive. In the late stages, HBsAg appears in the blood with difficulty, while anti-HBc IgM is usually still present. HBV-DNA, HBeAg, and anti-HBe are not detected consistently.

HBV-DNA can be determined by PCR in the plasma of HBsAg-negative patients.

Puncture liver biopsy for chronic hepatitis B

Histological examination can reveal chronic hepatitis, active cirrhosis and hepatocellular carcinoma. The permanent differential diagnostic criteria for chronic hepatitis B include the presence of HBsAg in the form of matt vitreous hepatocytes or characteristic staining with orsein, as well as the detection of HBeAg by an immunoperoxidase reaction. Other signs are of diagnostic value only if there are the above criteria. In chronic hepatitis caused by HBV, cirrhosis is less common in treatment than in autoimmune.

Laboratory data for chronic hepatitis B associated with the replicative phase

• General blood test: moderate anemia, lymphopenia, increased ESR;
• General analysis of urine without significant changes, but with high hepatitis activity, proteinuria, cylindruria, microhematuria are possible, as a manifestation of glomerulonephritis;
• Biochemical analysis of blood: hyperbilirubinemia and increase in the amount of conjugated bilirubin, hypoprothrombinemia, hypoalbuminemia and an increase in the content of alpha2 and y-globulins, an increase in the content of aminotransferases (the most characteristic increase in alanine aminotransferase), alkaline phosphatase, organ-specific liver enzymes (ornithylcarbamoyltransferase, arginase, fructose-1 -phosphoaldolase). The severity of hypertransaminotransferase corresponds to the degree of activity of chronic hepatitis. At low activity, the content of alanine aminotransferase is usually less than three norms, with moderate activity - from 3 to 10 norms, with high activity - more than 10 norms;
• Immunological analysis of blood: possible decrease in the number and function of T-lymphocyte suppressors, high antibody titers and a high degree of sensitization of T-lymphocytes to specific hepatic lipoprotein, an increase in the number of immunoglobulins; it is possible to detect circulating immune complexes;
• Serum markers of hepatitis B virus replication - HBV-DNA, HBeAg, HBsAblgM, DNA polymerase, pre-S antigens are determined. The most reliable criterion for confirming high replicative activity is the detection in the blood of high content of HBV-DNA (> 200 ng / l).

Morphological examination of the liver in chronic hepatitis B, associated with the replicative phase

When morphological examination of the liver (puncture biopsy), more often "stepped", and with a high activity of the inflammatory process - "bridge" and multilobular necrosis of liver parenchyma, lymphoid-histiocytic infiltration of portal tracts and lobules of the liver.

In the replicative phase, HBV DNA is detected in the liver tissue, HBcAg in the hepatocyte nuclei

To suspect the presence of hepatitis B virus in hepatocytes can be due to the presence of matte-vitreous hepatocytes in the study of drugs stained with hematoxylin and eosin or by the Van Gyzon method. These are large hepatocytes with a cytoplasm, a pale-colored eosin. It should be borne in mind that matte-vitreous hepatocytes occur not only in the presence of HBsAg, but also in drug and alcoholic hepatitis. However, matte-vitreous hepatocytes containing HBsAg are specifically stained with orsein and aldehyde fuchsin.

Instrumental data for chronic hepatitis B associated with the replicative phase

Radioisotope hepatology reveals a violation of the secretory-excretory function of the liver.

Ultrasound and radioisotope scanning reveal a diffuse increase in the liver.

The duration of the replicative phase and the degree of activity of the inflammatory process in the liver determine the course and prognosis of chronic hepatitis B. If viral replication stops before the development of cirrhosis, the prognosis is favorable, as the active phase of chronic hepatitis is transformed into inactive. Stopping the replication of the virus with the already formed cirrhosis of the liver can not lead to the reverse development of the process, but to a certain extent it allows to delay further progression of the disease.