RESUMO
Mechanisms leading to liver damage in chronic hepatitis C (CHC) are being discussed, but both the immune system and the virus are involved. The aim of this study was to evaluate intrahepatic viral infection, apoptosis and portal and periportal/interface infiltrate in paediatric and adult patients to elucidate the pathogenesis of chronic hepatitis C. HCV-infected, activated caspase-3(+) and TUNEL(+) hepatocytes, as well as total, CD4(+), CD8(+), Foxp3(+) and CD20(+) lymphocytes infiltrating portal and periportal/interface tracts were evaluated in 27 paediatric and 32 adult liver samples by immunohistochemistry or immunofluorescence. The number of infected hepatocytes was higher in paediatric than in adult samples (p 0.0078). In children, they correlated with apoptotic hepatocytes (activated caspase-3(+) r = 0.74, p < 0.0001; TUNEL(+) r = 0.606, p 0.0017). Also, infected (p = 0.026) and apoptotic hepatocytes (p = 0.03) were associated with the severity of fibrosis. In adults, activated caspase-3(+) cell count was increased in severe hepatitis (p = 0.009). Total, CD4(+), CD8(+) and Foxp3(+) lymphocyte count was higher in adult samples (p < 0.05). Paediatric CD8(+) cells correlated with infected (r = 0.495, p 0.04) and TUNEL(+) hepatocytes (r = 0.474, p = 0.047), while adult ones correlated with activated caspase-3(+) hepatocytes (r = 0.387, p 0.04). In adults, CD8(+) was associated with hepatitis severity (p < 0.0001) and correlated with inflammatory activity (CD8(+) r = 0.639, p 0.0003). HCV, apoptosis and immune response proved to be involved in CHC pathogenesis of both paediatric and adult patients. However, liver injury in paediatric CHC would be largely associated with a viral cytopathic effect mediated by apoptosis, while in adults it would be mainly associated with an exacerbated immune response.
Assuntos
Hepatite C Crônica/patologia , Fígado/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Apoptose , Criança , Pré-Escolar , Feminino , Imunofluorescência , Hepatócitos/patologia , Humanos , Imuno-Histoquímica , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/imunologiaRESUMO
The object of the present paper is to show four patients treated at the "Ricardo Gutiérrez" Children's Hospital, with diagnosis of complicated liver hydatid disease, since april 1977 until january 1997. The four patients were previously healthy, and were admitted with acute symptomatology, which varied depending on the kind of complication. They were all studied before surgery, except for one patient, with simple x-ray, abdominal ultrasonography, and in some cases with computerized tomography; in addition blood serologic analysis were performed, which allowed us 100% effectiveness in the diagnosis. The observed complications were two intrabiliary rupture of the hydatid cyst, one infection of the cyst, and one intra abdominal rupture. All patients underwent surgery, which confirmed the diagnosis, and an uneventful follow up of 20 years in the first child. In spite of the infrequent presentation of the complicated hydatid disease, in an endemic region it is not impossible for it to be seen. In this case it will require a well trained team of specialists, to solve not only the problems that the diagnosis and treatment mean, but also the possibility of a correct follow-up, with the resolution of the possible obstacle that might show-up for the disease itself, and from the changes that the surgery produces.