title: Alterations of biliary biochemical constituents and cytokines in infantile hepatitis syndrome.
abstract: OBJECTIVE
  To investigate the biliary biochemical constituents and cytokines in infantile hepatitis syndrome (IHS).
  
  
  METHODS
  From 42 IHS subjects and 21 controls, serum and biliary biochemical constituents, including total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (gamma-GT), total bile acid (TBA), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) both in bile and serum, were assayed. The subjects with IHS were divided into a cholestasis group (n = 21) and a hepatitis group (n = 21).
  
  
  RESULTS
  In the cholestasis group, serum TBIL, DBIL, ALT, gamma-GT, TBA, IL-6 and TNF-alpha levels were higher than those in the control (P < 0.01); and also the biliary TBIL, DBIL, gamma-GT and TBA levels were lower than those in the control, whereas biliary IL-6 and TNF-alpha levels were higher than those in the control (P < 0.01). In the cholestasis group, serum IL-6 and TNF-alpha levels were lower than those in bile (P < 0.01). In the hepatitis group, serum DBIL, ALT, gamma-GT, TBA, IL-6 and TNF-alpha levels were higher than those in the control (P < 0.01 or 140.57 +/- 70.32 vs 79.06 +/- 35.25, P < 0.05), while biliary TBIL, DBIL, gamma-GT and TBA levels were lower than those in the control (P < 0.01), and biliary IL-6 and TNF-alpha levels were higher than those in the control (P < 0.01). In the hepatitis group, serum IL-6 and TNF-alpha levels were also lower than those in bile (P < 0.01). Serum TBIL, DBIL, gamma-GT, IL-6 and TNF-alpha levels in the cholestasis group were higher than those in the hepatitis group, while biliary IL-6 and TNF-alpha levels in the cholestasis group were higher than those in the hepatitis group. Biliary IL-6 and TNF-alpha were found to be more significantly increased than serum IL-6 and TNF-alpha in IHS (P < 0.01). The biliary IL-6 and TNF-alpha levels were positively correlated with serum DBIL, TBA and gamma-GT levels in IHS subjects.
  
  
  CONCLUSIONS
  Biliary biochemical constituents alter in coincidence with pathological changes in hepatocellular injury. Cholestasis is more serious in IHS patients of cholestasis subtype. Assay of biliary IL-6 and TNF-alpha levels can be specific and sensitive to determine the inflammatory status of impaired liver in IHS.
authors.affiliation: Department of Gastroenterology and Hepatology, Wuhan Children's Hospital, Wuhan 430016, Hubei Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ding
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Hong
authors.initials: H
authors.lastname: Mei
authors.forename: Zhi-Hua
authors.initials: ZH
authors.lastname: Huang
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Zhang
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001646:Bile / Q000378:metabolism*; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006505:Hepatitis / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000378:metabolism*; D008297:Male; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin