TO study the value of corticosteroids in HBsAg-positive chronic active hepatitis, 18 pairs of liver histology comprising 36 liver biopsies from a prospective, randomized, controlled trial were evaluated. The median interval between the initial and follow-up histology was 8% months in 8 patients given prednisolone and 8% months in 10 Patients given placebo tablets. Following medication, there was significantly greater erosion of the limiting plate in the prenisolone group (p = 0.039) accompanied by a larger quantity of HBs& (p 0.045) and HBcAg (p = 0.006) in the liver. We conclude that prednisolone causes immunosuppression permitting enhanced viral multiplication and leads to increased erosion of the limiting plate. Our result also indicates that progression to cirrhosis is unhalted by prednisolone therapy. The histologic findings support clinico-biochemical conclusion that the use of prednisolone is deleterious to patients with HBsAg-positive chronic active hepatitis.
Clinical trials carried out in America, Australia, and Europe have established the benefit of corticosteroids in chronic active hepatitis (CAH) in reducing the activity and the mortality in its early active phase (1-4). The effects of steroids on Iiver histology and the degree to which they influence the long-term result of CAH, however, remain to be documented. Most of the clinical studies comprised a heterogeneity of CAH of different etiology, and the majority of the cases were HBsAg negative. Evidence is accumulating that HBsAg-positive CAH forms a separate entity distinguishable from the group of HBsAg-negative CAH in several clinical and biochemical characteristics (5). The benefits and risks of steroid therapy in HBsAg-positive CAH, in contrast to the HBsAg-negative group, have also been questioned (6).
The deleterious effects of steroid therapy in HBsAgpositive CAH have been recently reported from this hospital (7). This paper analyzes the histologic changes in the liver in two random groups of HBsAg-positive CAH given either pednisolone or placebo.
Methods
The patients admitted to our program were Chinese and conformed to all the following criteria of inclusion: (a) histologically verified CAH; (b) chronicity defined as