HEPATIC BILE DUCT LESIONS IN PATIENTS WITH CHRONIC HEPATITIS C; PREVALENCE AND SIGNIFICANCE

Introduction: Hepatic bile duct lesions (BDL), lymphoid aggregates or lymphoid follicles (LA/LF) and hepatic steatosis (HS) are common histological features, often observed in patients with chronic hepatitis C (VHC). The pathogenesis and clinical significance of hepatic BDL remain unclear. Material and method: We evaluated the prevalence and clinical significance of BDL on a group of 189 liver biopsies from patients with chronic viral hepatitis (125 patients with VHC and 64 with VHB), trying therewith to compare clinical, biochemical and morphologic data in patients with and without BDL. Results: The mean age of patients with BDL was 50.5 years, slightly higher than the one of patients without BDL (48.61 years). Analyzing the frequency and pathological significance of BDL and portal lymphocyte infiltrate in patients with VHC we noted: a higher frequency of BDL in patients with VHC than in those with VHB (55/125; 44% vs.14/64; 21.8%); a high level of serum alanin-aminotransferase (ALT) (93.83 U/l), alkaline phosphatase (AP) (175.83 U/l) and gamma-glutamil-transpeptidase (gGTP) (99.76 U/l) in patients with BDL vs. 71.73 U/l, 146.76U/l and 71.24 U/l, respectively, in those without these kind of lesions; serum triglyceride (TG), cholinesterase (CHE) and total bilirubin (TB) levels were found to be significantly higher in patients without BDL. We did not observe a relationship between the sex of the patients and the presence of blood transfusions in their history, between the two groups of patients. For the group of patients with VHC and BDL we observed a higher score of necroinflammation (9.87 vs. 7.38), portal inflammation (3.01 vs. 2.44) and fibrosis (1.65 vs. 0.97) and a higher frequency of LA/LF (49 vs. 36), as compared to patients without BDL. HS was found in 96 from the 125 (76.8%) patients with VHC, in 44 from 55 (80%) patients with BDL and in 52 from 70 (74.3%) of those without BDL. Conclusion: The incidence of hepatic BDL is highly related to the severity of the histopathological lesions, being higher in patients with advanced liver disease and cholestasis. The implication and molecular role of hepatitis C virus in the pathogenesis of BDL requires further studies.