Wanless I R, Nakashima E, Sherman M
Department of Laboratory Medicine and Pathobiology, Toronto General Hospital and University of Toronto, Ontario, Canada.
Arch Pathol Lab Med. 2000 Nov;124(11):1599-607. doi: 10.5858/2000-124-1599-ROHC.
Cirrhosis is widely regarded as being irreversible. Recent studies have demonstrated that fibrosis may decrease with time in humans and experimental animals if the disease activity becomes quiescent. The histologic appearance of regressing cirrhosis in the human has not been described in detail.
To define histologic parameters that indicate regression of cirrhosis and to provide an interpretation of how regression occurs from a histologic point of view.
A patient who underwent a series of biopsies that showed apparent regression of hepatitis B cirrhosis is presented. In addition, 52 livers removed at transplantation having cirrhosis or incomplete septal cirrhosis were graded for histologic parameters that suggest progression or regression of fibrosis. Progression parameters were steatohepatitis, inflammation, bridging necrosis, and piecemeal necrosis. The regression parameters (collectively called the hepatic repair complex) were delicate perforated septa, isolated thick collagen fibers, delicate periportal fibrous spikes, portal tract remnants, hepatic vein remnants with prolapsed hepatocytes, hepatocytes within portal tracts or splitting septa, minute regenerative nodules, and aberrant parenchymal veins.
Regression parameters were found in all livers and were prominent in the majority. Livers with micronodular cirrhosis, macronodular cirrhosis, and incomplete septal cirrhosis demonstrate a histologic continuum. A continuum of regressive changes was also seen within individual livers. These appearances allow one to understand visually how fibrous regions of hepatic parenchyma can be returned toward a normal appearance. Many examples of incomplete septal cirrhosis could be the product of regressed cirrhosis.
肝硬化被广泛认为是不可逆的。最近的研究表明，如果疾病活动静止，人类和实验动物的纤维化可能会随时间减少。人类肝硬化消退的组织学表现尚未详细描述。
定义表明肝硬化消退的组织学参数，并从组织学角度解释消退是如何发生的。
报告一名接受了一系列活检的患者，活检显示乙肝肝硬化明显消退。此外，对52例移植时切除的患有肝硬化或不完全间隔性肝硬化的肝脏进行组织学参数分级，这些参数提示纤维化的进展或消退。进展参数包括脂肪性肝炎、炎症、桥接坏死和碎片状坏死。消退参数（统称为肝修复复合体）包括纤细的穿孔间隔、孤立的粗大胶原纤维、纤细的汇管区纤维刺、汇管区残余、伴有肝细胞脱垂的肝静脉残余、汇管区内或分隔间隔内的肝细胞、微小再生结节和异常的实质静脉。
在所有肝脏中均发现消退参数，且大多数肝脏中这些参数较为突出。小结节性肝硬化、大结节性肝硬化和不完全间隔性肝硬化的肝脏呈现出组织学上的连续性。在个体肝脏中也观察到了消退变化的连续性。这些表现使人们能够直观地理解肝实质的纤维区域如何恢复到正常外观。许多不完全间隔性肝硬化的例子可能是消退性肝硬化的产物。
