Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.577
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
Processing time: 86 Days and 0 Hours
Chronic hepatitis B (CHB) and primary biliary cholangitis (PBC) are chronic liver diseases; however, CHB combined with PBC is uncommon.
There are few studies on the clinical and pathological characteristics of CHB combined with PBC, and current research is limited to case reports.
To explore the clinicopathological characteristics, diagnoses, and treatments of patients with CHB and PBC.
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.
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.
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.
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.