Regression of fibrosis in paediatric autoimmune hepatitis: morphometric assessment of fibrosis versus semiquantiatative methods

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• 作者：Ahmed F Abdalla (1)
  Khaled R Zalata (2)
  Abeer F Ismail (1)
  Gamal Shiha (3)
  Mohamed Attiya (3)
  Ahmed Abo-Alyazeed (4)
  
• 刊名：Fibrogenesis & Tissue Repair
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：2
• 期：1
• 全文大小：476KB
• 参考文献：1. Gregorio GV, Portmann B, Reid F, Donaldson PT, Doherty DG, McCartney M, Mowat AP, Vergani D, Mieli-Vergani G: Autoimmune hepatitis in childhood. A 20 year survey. / Hepatology 1997, 25:541-47. CrossRef
  2. Czaja AJ, Freese DK: Diagnosis and treatment of autoimmune hepatitis. / Hepatology 2002, 36:479-97. CrossRef
  3. Czaja AJ, Menon KVN, Carpenter HA: Sustained remission after corticosteroid therapy of type 1 autoimmune hepatitis: a retrospective analysis. / Hepatology 2002, 35:890-97. CrossRef
  4. Baranov AA, Kaganov BS, Gundobina OS, Zainudinov ZM: Autoimmune hepatitis in children. / Int Pediatr 2003, 18:23-9.
  5. Powell LW, Kerr JF: Reversal of cirrhosis in idiopathic haemochromatosis following long-term intensive venesection therapy. / Australas Ann Med 1970, 19:54-7.
  6. Hammel P, Couvelard A, O'Toole D, Ratouis A, Sauvanet A, Flejou JF, Degott C, Belghiti J, Bernades P, Valla D, Ruszniewski P, Lévy P: Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. / N Engl J Med 2001, 344:418-23. CrossRef
  7. Muretto P, Angelucci E, Lucarelli G: Reversibility of cirrhosis in patients cured of thalessemia by bone marrow transplantation. / Ann Intern Med 2002, 136:667-72.
  8. Kaplan MM, DeLellis RA, Wolfe HJ: Sustained biochemical and histologic remission of primary biliary cirrhosis in response to medical treatment. / Ann Intern Med 1997, 126:682-88.
  9. Falkmer S, Samuelson G, Sjolin S: Penicillamine-induced normalization of clinical signs, and liver morphology and histochemistry in a case of Wilson's disease. / Pediatrics 1970, 45:260-68.
  10. Dufour JF, DeLellis R, Kaplan MM: Regression of hepatic fibrosis in hepatitis C with long-term interferon treatment. / Dig Dis Sci 1998, 43:2573-576. CrossRef
  11. Poynard T, McHutchinson J, Manns M, Trepo C, Lindsay K, Goodman Z, Ling MH, Albrecht J: Impact of interferon alpha-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. / Gastroenterology 2002, 122:1303-313. CrossRef
  12. Lau DT, Kleiner DE, Park Y, Di Bisceglie AM, Hoofnagle JH: Resolution of chronic delta hepatitis after 12 years of interferon alfa therapy. / Gastroenterology 1999, 117:1229-233. CrossRef
  13. Kweon YO, Goodman ZD, Dienstag JL, Schiff ER, Brown NA, Burchardt E, Schoonhoven R, Brenner DA, Fried MW: Decreasing fibrogenesis: an immunohistochemical study of paired liver biopsies following lamivudine therapy for chronic hepatitis B. / J Hepatol 2001, 35:749-55. CrossRef
  14. Zimmerman H, Reichen J, Zimmerman A, Sagesser H, Thenisch B, Hoflin F: Reversibility of secondary biliary fibrosis by biliodigestive anastomosis in the rat. / Gastroenterology 1992, 103:579-89.
  15. Dunn MA, Cheever AW, Paglia LM, Kelly EP, Duvall RH, Andrade ZA, Goldner FH: Reversal of advanced liver fibrosis in rabbits with Schistosomiasis japonica. / Am J Trop Med Hyg 1994, 50:499-05.
  16. Dufour IF, Dellelis R, Kaplan MM: Reversibility of hepatic fibrosis in autoimmune hepatitis. / Ann Intern Med 1997, 127:981-85.
  17. Cotler SJ, Jakate S, Jensen DM: Resolution of cirrhosis in autoimmune hepatitis with corticosteroid therapy. / J Clin Gastroenterol 2001, 32:428-30. CrossRef
  18. Ferreira AR, Roquete MLV, Toppa NH, Fonseca de Castro LPF, Fagundes EDT, Penna FJ: Effect of treatment on hepatic histopathology in children and adolescents with autoimmunehepatitis. / J Pediatr Gastroenterol Nutr 2008, 46:65-0. CrossRef
  19. Pilette C, Rousselet MC, Bedossa P, Chappard D, Oberti F, Rifflet H, Ma?ga MY, Gallois Y, Calès P: Histopathological evaluation of liver fibrosis: quantitative image analysis Vs semi-quantitative scores. / J Hepatol 1998, 28:439-46. CrossRef
  20. Goodman ZD, Becker RL, Pockros PJ, Afdhal NH: Progression of fibrosis in advanced chronic hepatitis C: evaluation by morphometric image analysis. / Hepatology 2007, 45:886-94. CrossRef
  21. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M: International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. / J Hepatol 1999, 31:929-38. CrossRef
  22. Ishak K, Baptista A, Bianchi L, Callea F, Groote JD, Gudat F, Denk H, Desmet V, Korb G, MacSween RN: Histological grading and staging of chronic hepatitis. / J Hepatol 1995, 22:696-99. CrossRef
  23. Bedossa P, Poynard T: An algorithm for the grading of activity in chronic hepatitis C. / Hepatology 1996, 24:289-93. CrossRef
  24. Friedman SL: The cellular basis of hepatic fibrosis: mechanisms and treatment strategies. / N Engl J Med 1993, 328:1828-835. CrossRef
  25. Olaso E, Friedman SL: Molecular regulation of fibrogenesis. / J Hepatol 1998, 29:836-47. CrossRef
  26. Bonis PA, Friedman SL, Kaplan MM: Is liver fibrosis reversible? / N Engl J Med 2001, 344:52-54. CrossRef
  27. Friedman SL: Seminars in medicine of the Beth Israel Hospital, Boston. The cellular basis of hepatic fibrosis. Mechanisms and treatment strategies. / N Engl J Med 1993, 328:1828-836. CrossRef
  28. Friedman SL: Molecular regulation of hepatic fibrosis, an integrated cellular response to tissue injury. / J Biol Chem 2000, 275:2247-250. CrossRef
  29. Murphy FR, Issa R, Zhou X, Rhatnarajah S, Nagase H, Arthur MJ, Benyon C, Iredale JP: Inhibition of apoptosis of activated hepatic stellate cells by tissue inhibitor of metalloproteinase-1 is mediated via effects on matrix metalloproteinase inhibition: implications for reversibility of liver fibrosis. / J Biol Chem 2002, 277:11069-1076. CrossRef
  30. Issa R, Williams E, Trim N, Kendall T, Arthur MJP, Reichen J, Benyon RC, Iredale JP: Apoptosis of hepatic stellate cells: involvement in resolution of biliary fibrosis and regulation by soluble growth factors. / Gut 2001, 48:548-57. CrossRef
  31. Parrelli JM, Meisler N, Cutroneo KR: Identification of a glucocorticoid response element in the human transforming growth factor beta 1 gene promoter. / Int J Biochem Cell Biol 1998, 30:623-27. CrossRef
  32. Cai J, Zheng T, Lotz M, Zhang Y, Masood R, Gill P: Glucocorticoids induce Kaposi's sarcoma cell proliferation through the regulation of transforming growth factor beta. / Blood 1997, 89:1491-500.
  33. Centrella M, McCarthy TL, Canalis E: Glucocorticoid regulation of transforming growth factor beta 1 activity and binding in osteoblast enriched cultures from fetal rat bone. / Mol Cell Biol 1991, 11:4490-496.
  34. Shukla A, Meisler N, Cutroneo KR: Perspective article: transforming growth factor-beta: cross road of glucocorticoid and bleomycin regulation of collagen synthesis in lung fibroblasts. / Wound Repair Regen 1999, 7:133-40. CrossRef
  35. Almawi WY, Beyhum HN, Rahme AA, Rieder MJ: Regulation of cytokine and cytokine receptor expression by glucocorticoids. / J Leukoc Biol 1996, 60:563-72.
  36. Almawi WY: Molecular mechanisms of glucocorticoid effects. / Mod Asp Immunobiol 2001, 2:78-2.
  37. Mohamadnejad M, Malekzadeh R, Nasseri-Moghaddam S, Hagh-Azali S, Rakhshani N, Tavangar SM, Sedaghat M, Alimohamadi SM: Impact of immunosuppressive treatment on liver fibrosis in autoimmune hepatitis. / Dig Dis Sci 2005, 50:547-51. CrossRef
  38. Czaja AJ, Carpenter HA: Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis. / J Hepatol 2004, 40:646-52. CrossRef
  39. Schvarez R, Glaumann H, Weiland O: Survival and histological resolution of fibrosis in autoimmune chronic active hepatitis. / J Hepatol 1993, 18:15-3. CrossRef
  
• 作者单位：Ahmed F Abdalla (1)
  Khaled R Zalata (2)
  Abeer F Ismail (1)
  Gamal Shiha (3)
  Mohamed Attiya (3)
  Ahmed Abo-Alyazeed (4)
  
  1. Department of Paediatrics, Hepatology & Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  2. Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  3. Department of Internal Medicine, Hepatology & Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  4. Department of Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  

文摘

Background Regression of hepatic fibrosis in patients with autoimmune hepatitis (AIH) has been described in response to immunosuppressive therapy. These studies, however, besides being few in number, were conducted on adult populations. Our aim was to assess the regression of hepatic fibrosis, using morphometric assessment of fibrosis versus semi-quantitative methods, in children with AIH who achieved clinical and biochemical remission. Thirteen patients who achieved clinical and biochemical remission were included in the study, out of 62 children with AIH. Repeat biopsy was performed after 6 to 12 months of clinical and biochemical remission. Morphometric assessment of fibrosis was performed and correlated with METAVIR and Ishak semi-quantitative scores. Results The study group included eight male and five female patients. The median age at presentation was 4 years (range 2 to 12 years). The mean duration of treatment was 22 ± 7.3 months, and the mean interval between biopsies was 26.2 ± 6.5 months. Following therapy, there was significant reduction in aspartate aminotransferase, ALT and IgG levels as well as improvement of necroinflammation. The mean fibrosis scores were significantly decreased from 4.5 ± 1.19 and 2.9 ± 0.7 before therapy to 2.7 ± 1.16 and 2 ± 0.8 after treatment as assessed by Ishak and METAVIR scores, respectively (P = 0.001 and 0.004). The mean morphometric assessment of fibrosis before treatment was 20% ± 9.7 and following therapy it decreased to 5.6% ± 3.9 (P = 0.000). Conclusion Significant regression of fibrosis in paediatric AIH could occur with current therapeutic regimens. Morphometric assessment of fibrosis is more sensitive than semi-quantitative methods to identify changes in fibrosis.