Гепатиты

Interpretation of Diagnostic Tests
for Hepatitis B (cont.)
Chronic Chronic Healthy
Test Hepatitis B Precore Carrier
HBsAg + + +
anti-HBs
HBeAg +
anti-HBe + +
anti-HBc + + +
IgM anti-HBc
HBV DNA* +/ +/
ALT Elevated Elevated Normal
*By conventional assay. A lower level of viremia may be detected by other more sensitive tests such as PCR.
Shetty K and Younossi ZM. Practical Gastroenterology. 1998;22:39-47.

Evaluation of Liver Disease in HBV Infection
Indicator
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Bilirubin
Prothrombin time (PT)
Albumin
Liver histology
Ultrasound
Interpretation*
suggests hepatocyte damage
suggests hepatocyte damage†
suggests hepatic dysfunction
suggests hepatic dysfunction
suggests hepatic insufficiency
Indicator of disease stage & grade
Identifies tumors/cirrhosis
* Indicates typical use of indicators for evaluating liver disease.
†AST elevations are less liver-specific than ALT, and may indicate damage of other tissue types.

Knodell Scoring System for Liver Biopsies
Knodell RG et al. Hepatology. 1982:1:431-435.
Category
Components Evaluated
Grade*
1. Periportal necrosis with
or without bridging necrosis 0-10
2. Intralobular degeneration
and focal necrosis 0-4
3. Portal inflammation 0-4
4. Fibrosis 0-4
Stage†
*The Grade score reflects severity of necrosis and inflammation.
†The Stage score indicates scarring, or potentially irreversible disease progression.
Range of Scores

Healthy Liver
The liver is the largest organ in the body & stores vitamins A1, B12, D, E, & K
metabolizes lipids
manufactures cholesterol
stores glycogen

Fibrosis
Hepatic fibrosis is the overgrowth
of connective tissue within the liver,
which restricts the liver´s ability to
function normally.

Cirrhosis
The term cirrhosis refers to widespread
fibrosis and nodule formation within the
liver. Its presence implies previous or
continuing hepatic damage.

Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC)
describes primary cancer of the liver,
one of the most common carcinomas
in the world.

Chronic Hepatitis B: Summary
HBsAg+ for >6 months
Variable clinical course
Morbidity and mortality from chronic
necroinflammatory disease in liver
Disease progression is associated with persistently
high HBV replication