Sistema de classificação histológica de Nakanuma em uma coorte brasileira: correlações clínicas e bioquímicas na colangite biliar primária e na colangite esclerosante primária
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".