Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2023; 15(4): 577-584
Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.577
Clinicopathological features of 11 cases of chronic hepatitis B infection complicated with primary biliary cholangitis
Yun Ye, Qian Zhang, Zhong-Hua Lu, You-Wen Tan
Yun Ye, Qian Zhang, You-Wen Tan, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
Zhong-Hua Lu, Department of Liver Disease, Wuxi No. 5 People’s Hospital Affiliated to Jiangnan University, Wuxi 214000, Jiangsu Province, China
Author contributions: Ye Y, Zhang Q, and Lu ZH contributed equally to the research; Tan YW and Ye Y designed the research; Zhang Q and Lu ZH collected and analyzed the data and drafted the manuscript; Tan YW performed the liver pathological evaluations; Tan YW and Ye Y wrote and revised the manuscript; all authors read and approved the final version for publication.
Supported by the Social Development Project of Jiangsu Province, No. BE2020775; and Chinese Federation of Public Health Foundation, No. GWLM202002.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the Third Hospital of Zhenjiang Affiliated Jiangsu University (No. 202238).
Informed consent statement: Informed consent for liver biopsy and treatments were obtained from the patients.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Wen Tan, MD, Chief Doctor, Professor, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300 Daijiamen, Runzhou Distinct, Zhenjiang 212003, Jiangsu Province, China. tyw915@sina.com
Received: January 24, 2023
Peer-review started: January 24, 2023
First decision: March 6, 2023
Revised: March 9, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 27, 2023
Research background

Chronic hepatitis B (CHB) and primary biliary cholangitis (PBC) are chronic liver diseases; however, CHB combined with PBC is uncommon.

Research motivation

There are few studies on the clinical and pathological characteristics of CHB combined with PBC, and current research is limited to case reports.

Research objectives

To explore the clinicopathological characteristics, diagnoses, and treatments of patients with CHB and PBC.

Research methods

Eleven patients with chronic hepatitis B virus (HBV) infection and PBC who underwent liver biopsy at our hospital between January 2005 and September 2020 were selected. Demographic data, clinical biochemical indicators, autoantibodies, and virological indicators were also collected. The liver pathology was evaluated using the METAVIR and Ludwig staging systems.

Research results

Eleven patients with CHB were diagnosed with PBC, and nine were anti-mitochondrial antibody-M2 positive. Alkaline phosphatase (ALP) increased in five of the 11 cases. ALP levels were normal in six patients, but γ-glutamyl transferase levels were elevated in four patients. Pathological changes were primarily caused by inflammation of the portal area. All cases showed bile duct injury, five cases showed a typical florid duct region, and three cases with severe interfacial inflammation showed similar autoimmune hepatitis-PBC-like injury with few plasma cells. All the patients received antiviral and ursodeoxycholic acid treatment.

Research conclusions

For the first time, the pathological characteristics of rare CHB complicated with PBC were observed in a large sample size. A normal ALP level cannot exclude the diagnosis of PBC. The pathological characteristics were similar to those of PBC-autoimmune hepatitis, but with fewer plasma cells.

Research perspectives

Attention should be paid to the possibility of HBV combined with PBC. Pathology can provide important information, even if biochemical changes or specific antibodies are negative.