Objective: To study the pathological feature, viral distribution and replication in the liver tissue of sporadic hepatitis E(HE), and to explore the mechanism of the liver injury induced by hepatitis E virus(HEV).
Methods: The total bioptic liver tissues (n=54) were obtained from the patients with sporadic hepatitis E, including the clinical acute stage (n=20), the convalescent stage (n=16), and the chronic hepatitis B (CHB) overlapped with HEV infection recently (n=18). The pathological changes in the liver tissues were observed under the light and the electron microscope. HEV RNA was detected by in situ hybridization, and Kupffer cells were marked with immunohistochemistry.
Results: The HE liver tissues showed the pathological features in the clinical acute stage, presenting frequently with feathery degeneration of hepatocytes (100%), cholangiolar cholestasis (75.0%), and double nuclei and multinuclei hepatocytes (65.0%). The apoptotic body of hepatocyte was larger and irregular, and the proliferation of Kupffer cells was prominent. HEV RNA was distributed in hepatocyte cytoplasm near the nuclei. The positive rate of HEV RNA in acute stage was evidently higher than that in convalescent stage (100% vs 12.5%,P < 0.001), and the HEV RNA positive hepatocytes and the viral copies in acute stage were also more than in convalescent stage, in which the liver tissues were becoming normal. The liver tissue changes of the CBH overlapped with HEV infection were more severe compared with the single CHB.
Conclusions: Sporadic HE had histopathological characteristics. HEV infection and replication in hepatocytes occurred mainly during clinical acute stage and regressed in convalescent stage, which suggested sporadic acute HE may have a good result. The immune-mediated liver injury by lymphocytes might be a main pathogenesis of HE,but the liver injury induced directly by HEV might not be excluded.