Zarski Jean-Pierre, Mc Hutchison John, Bronowicki Jean-Pierre, Sturm Nathalie, Garcia-Kennedy Richard, Hodaj Enkelejda, Truta Brenda, Wright Teresa, Gish Robert
Département d'Hépato-gastroentérologie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 9, France.
J Hepatol. 2003 Mar;38(3):307-14. doi: 10.1016/s0168-8278(02)00387-2.
BACKGROUND/AIMS: The interval at which liver biopsy should be repeated in untreated patients with chronic hepatitis C is not defined. We examined fibrosis change by METAVIR scoring in these patients in whom two or more liver biopsies were available.
One hundred and eighty patients with histologically proven chronic hepatitis C were studied. Mean delay between biopsies was 3.67+/-2.69 years and 3.08+/-1.43 in the 16 patients having three biopsies. Univariate and multivariate analyses were performed to determine factors associated with liver fibrosis progression.
Median rate of fibrosis progression per year was 0.04 (0.00-0.55) to first biopsy, 0.00 (-0.84-1.02) between first and second biopsy (NS), and 0.17 (0.00-1.50) between second and third biopsy (P<0.05). In multivariate analysis, only age at first biopsy >40 years (OR=5) (2-12) and alcohol consumption of 1-50 g per day (OR=4) (2-12) and more than 50 g per day (OR=8) (3-23) were associated with severe fibrosis. The number of patients who increased in fibrosis stage was significantly higher after 4 years (P<0.02).
An interval of at least 4-5 years is needed between liver biopsies to measure change in patients with mild liver disease.
背景/目的：对于未经治疗的慢性丙型肝炎患者，肝活检应重复进行的间隔时间尚无定论。我们通过METAVIR评分检查了这些有两次或更多次肝活检结果的患者的纤维化变化情况。
对180例经组织学证实为慢性丙型肝炎的患者进行研究。活检之间的平均间隔时间为3.67±2.69年，在16例进行了三次活检的患者中为3.08±1.43年。进行单因素和多因素分析以确定与肝纤维化进展相关的因素。
首次活检时纤维化每年进展的中位数为0.04（0.00 - 0.55），首次与第二次活检之间为0.00（-0.84 - 1.02）（无显著性差异），第二次与第三次活检之间为0.17（0.00 - 1.50）（P<0.05）。多因素分析中，仅首次活检时年龄>40岁（OR = 5）（2 - 12）以及每天饮酒1 - 50克（OR = 4）（2 - 12）和每天饮酒超过50克（OR = 8）（3 - 23）与严重纤维化相关。4年后纤维化分期增加的患者数量显著更高（P<0.02）。
对于轻度肝病患者，肝活检之间至少需要间隔4至5年以测量变化情况。
