Sistema de classificação histológica de Nakanuma em uma coorte brasileira: correlações clínicas e bioquímicas na colangite biliar primária e na colangite esclerosante primária

Abstract

ackground: Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC) are chronic liver diseases with distinct epidemiological profiles. This study aims to evaluate the application of the Nakanuma scoring system in a Brazilian cohort, exploring its correlation with clinical and laboratory parameters in PBC and PSC. Methods: This retrospective study included 32 PBC cases and 36 PSC cases from the Hospital das Clínicas da Universidade Federal de Minas Gerais and other hepatology services in Belo Horizonte, Brazil. Histopathological changes were assessed using the Nakanuma’s Classification System. Clinical and laboratory data, including serum levels of as- partate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP), were analyzed. Correlations between histological scores and clinical parameters were examined. Results: The PBC group consisted of 30 women and 2 men, with an average age of 58.2 years. The PSC group comprised 24 men and 12 women, with an average age of 35.7 years. In PSC patients, cholangitic activity was significantly associated with AST and ALT serum levels. In PBC patients, a significant correlation was observed between higher histological stages and increased ALP serum levels. Nakanuma Stage 3 and 4 correlated with ALP > 1,67 x upper limit of normality, indicating a weaker clinical response to ursodeoxycholic acid treatment, which aligns with long-term prognosis as per the Toronto Criteria. However, these criteria did not hold significance for PSC in our study. Conclusion: Our study reveals a noteworthy association between Nakanuma’s grading of Cholangitis Activity and serum ALT and AST levels in PSC. Additionally, we observed a correlation between serum ALP and histological stage, both of which negatively scale with treatment response and, hence, long-term prognosis. These findings underscore the utility of the Nakanuma classification system in providing valuable insights into disease progression and prognosis in the Brazilian population. Keywords: Primary biliary cholangitis, primary sclerosing cholangitis, histopathology, Nakanuma classification system.