Pathological changes and clinical manifestations of 1020 children with liver diseases confirmed by biopsy

Objective To evaluate value of liver biopsy in diagnosis of liver disease in children and explore relationship between pathological changes and clinical manifestations of children with liver diseases. Methods The one-second liver biopsy was performed in 1023 patients with liver diseases treated in our department from 1983 to 2000. Diagnosis of viral hepatitis was based on the diagnostic criteria formulated by The Chinese Society of Infectious and Parasitic Diseases in 1995. The degree of hepatic inflammatory change activity was defined as 0～4 grade (G_ 0～4 ). Results (1) Liver biopsy was successful in 1 020 cases (99.7%, 1 020/1 023), including 135 infants and young children (3 years of age). Liver biopsy had been applied in 90% hospitalized patients with chronic liver diseases since 1991. (2) Hepatitis viruses were the leading etiologic factor in chronic liver diseases (96.6%, 985/1020), among which, hepatitis B virus ranked the first; 75.4% of patients had hepatitis B. (3) Sixty-nine patients had liver impairment induced by non-viral factors (13.5%, 69/509, χ 2 = 15.1, P 0.001), including disorders related to fat metabolism (21.4%), Wilson′s disease (20.4%), glycogen storage disease (10.2%), progressive muscular dystrophy (9.2%), and autoimmune hepatitis (7.1%). (4) Hepatic inflammatory injuries (G_2) were found in 76.4% of children with hepatitis B as compared with 61.2% in adults (χ 2 =9.15, P 0.01); it aggravated with age in children with hepatitis B and C and peaked at the schooling stage (χ 2 =4.45～52.97, P 0.05～0.001). Moderate or severe liver injuries were not seen in infants with chronic hepatitis B. Two infants had chronic hepatitis C (2/6). (5) Liver pathological changes in patients with non-viral hepatitis had specific histological changes, non-specific histological changes and liver cirrhosis. Conclusions Liver biopsy in children is safe, important and feasible. Hepatitis viruses were major etiologic agents in children with liver diseases, among which, hepatitis B virus was ranked the first. Liver inflammatory injuries in children with hepatitis B were seen more often than those in adults, the most severe inflammatory changes were seen in children with hepatitis B and C at school ages. Liver injuries induced by non-viral factors seemed to be increasing year by year. Liver biopsy can help in diagnosis of liver disease or provide important clues.