A seroimmunologic evaluation of 57 children with chronic hepatitis is presented. Twenty-one patients had chronic persistent hepatitis and 36 had chronic active hepatitis. Serum samples obtained before treatment were tested for HBsAg, anti-HBs, anti-HBc, smooth muscle antibody, and antibody to endoplasmic reticulum. A persistently positive HBsAg was observed in the serum of 1 8 of the 21 patients with chronic persistent hepatitis. The chronic active hepatitis group was divided into three subgroups according to the presence of hepatitis B-virus markers (7 patients), smooth muscle antibody (10 patients), and endoplasmic reticulum antibody (9 patients). Determination of these markers could be useful for classifying children with chronic hepatitis.
Chronic hepatitis is defined as an unresolving inflammatory lesion of the liver (1); it is classified into chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH). Patients with CPH are usually asymptomatic, exhibiting only a minimal persistent or recurrent elevation of serum transaminases. Their disease, which is characterized histologically by portal inflammation with no evidence of piecemeal necrosis or fibrosis (2), usually resolves spontaneously. Patients with CAH present with more prominent clinical features and greater abnormalities of liver function tests; on histological grounds, the disease is characterized by piecemeal necrosis, inflammation, and fibrosis (2). CAH is frequently associated with a poor long-term prognosis and often requires prolonged therapy. Infection with hepatitis B virus (HBV) may lead to chronic hepatitis, which may also be due to non-A, non-B virus (3). Other cases are apparently of nonviral origin and are considered to belong to an autoimmune group characterized by the presence of nonorgan-specific antibodies such as antinuclear antibody, smooth muscle antibody (SMA), and elevated serum globulin (3, 4).
This report concerns our experience with seroimmunologic evaluation of 57 children with chronic hepatitis, the results of which suggest a new classification. PATIENTS Twenty-one children with CPH and 36 with CAH were studied. The diagnoses were established in all by clinical,