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(Established in March 1996)
Dr. Wu's Liver diseases
|Chronic Hepatitis (Etiology) |
for professionals (medical students and residents)
(Posted Sep. 16, 1996; Updated May 14, 2009)
Chronic Hepatitis (Etiology)
(Key words: chronic hepatitis, etiology)
- Virus (HBV, HCV, HDV), Drug, Toxin, Autoimmune, Cryptogenic
- Prevalence: different depends on geographical region, ethnic back ground, high risk behavior.
- Etiological viruses can be identified by serological tests.
- 1. HBV:
- Serum tests for HBsAg, HBeAg, HBV-DNA and histological
verification of HBcAg.
- Serum HBsAg ( + ), HBeAg ( + ), HBV-DNA ( + )”Gpersisting replication of viruses
- Serum HBeAg ( - ), HBV-DNA ( - ) with anti-HBe ( + )”Gusually present with
milder clinical symptoms with less viruses --- usually seen in
- HBV variant (precore or HBeAg negative mutant) --- Failure to produce HBeAg, but with persistent anti-HBe ( + ) and HBV-DNA ( + ) ---
persistent progression of hepatic inflammation.
- 2. HCV:
- Serum anti-HCV and HCV-RNA (+) --- histplogical activity
is related to degree of viral replication.
- In some cases, there are production of autoantibodies such as:
ANA, anti-LKM (anti-liver and kidney microsomes).
- 3. HDV:
- Serum anti-HDV and HDV-RNA ( + )
- Serum HBsAg: usually ( + )
- 4. Autoimmune:
- Patients losing immunological tolerance of liver itself.
- Various factors as: environment and varied contageous agents trigger
- Female predominance.
- Serum hypergammaglobulinemia: more predominant.
- HLA Type: predominantly B8, DR3, DR4
- Frequently associated with autoimmune diseases such as: thyroiditis,
ulcerative colitis, Sjogren's syndrome.
- With characteristic serum autoimmune antibodies such as: ANA, Anti-LKM
antibody, anti-smooth muscle antibody, anti-soluble liver antigen
antibody, anti-liver-pancreas antigen antibody, anti-asialoglycoprotein
receptor antibody, anti-heptocyte plasma membrane antigen antibody.
- Absence of serum markers of HBV, HCV and HDV infections and anti-mitochrondrial
- Well respond to corticosteroid and/or immunosuppressive therapy.
- Subgroups of autoimmune hepatitis:
- Autoimmune hepatitis type 1: high titers of ANA or SMA.
- Autoimmune hepatitis type 2: presence of anti-LKM-1 directed against
cytochrome P-450 IID6.
- Autoimmune hepatitis type 3: presence of soluble liver antigen
antibodies in the absence of ANA or anti-LKM.
- 5. Drug-induced chronic hepatitis:
- drugs as a cause of liver injury.
- 6. Cryptogenic chronic hepatitis:
- without evidence of viral, drug-induced
or autoimmune induced liver injuries.
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(By Jau-Shin Wu, M.D.; Posted Sep. 16, 1996; Revised May 12, 2009)
(TMN) Since June 09, 2002
(Dr. Wu's Liver D) Since Jan. 01, 2008
(Olddoc)Since Jan. 01, 2008
(TMN) Since Jan. 01, 2008