Bain V G, Bonacini M, Govindarajan S, Ma M, Sherman M, Gibas A, Cotler S J, Deschenes M, Kaita K, Jhangri G S
Division of Gastroenterology, University of Alberta, 205, 8215-112 st, Edmonton, Alberta, Canada.
J Viral Hepat. 2004 Jul;11(4):375-82. doi: 10.1111/j.1365-2893.2004.00520.x.
The role of liver biopsy in the assessment of chronic hepatitis C is generally accepted yet there is no prospective data available to quantify its contribution. A previous single centre pilot study suggested that the clinician could predict the amount of fibrosis and to a lesser extent, inflammation with moderate accuracy. The 2002 National Institute of Health Hepatitis C Consensus Conference recommended further study of the role of liver biopsy. Our objective was to compare a prediction of biopsy findings by expert clinicians using usually available clinical and laboratory data to actual biopsy results in order to determine whether biopsy is required routinely. This was a prospective observational study conducted at seven university centres in which the accuracy of clinician's predictions of the degree of inflammation and fibrosis were compared with the actual liver biopsy using an adaptation of a standard histological scoring system. We studied 81 adults with previously untreated chronic hepatitis C, raised serum transaminases and positive HCV-RNA in serum. Clinicians predicted the inflammatory grade in 44 of 80 cases (55%) and the fibrosis stage in 46 of 81 cases (57%). Nine of 17 cirrhotic cases were predicted (sensitivity 53%, specificity 56%). No unexpected additional diagnoses were made on the biopsies. Thus despite knowledge of the clinical and laboratory investigations of patients with hepatitis C, clinicians are unable to accurately predict the hepatic inflammatory grade and fibrotic stage. Liver biopsy is an essential investigation to accurately evaluate the grade and stage of liver disease patients with hepatitis C.
肝活检在慢性丙型肝炎评估中的作用已得到普遍认可，但尚无前瞻性数据可用于量化其贡献。先前一项单中心试点研究表明，临床医生能够以中等准确度预测纤维化程度，在较小程度上也能预测炎症程度。2002年美国国立卫生研究院丙型肝炎共识会议建议进一步研究肝活检的作用。我们的目的是比较专家临床医生使用通常可得的临床和实验室数据对活检结果的预测与实际活检结果，以确定是否需要常规进行活检。这是一项在七个大学中心开展的前瞻性观察性研究，其中使用一种标准组织学评分系统的改编版，将临床医生对炎症和纤维化程度预测的准确度与实际肝活检结果进行比较。我们研究了81例既往未接受治疗的慢性丙型肝炎成人患者，这些患者血清转氨酶升高且血清HCV-RNA呈阳性。临床医生对80例中的44例（55%）预测了炎症分级，对81例中的46例（57%）预测了纤维化分期。17例肝硬化病例中有9例被预测到（敏感性53%，特异性56%）。活检未做出意外的额外诊断。因此，尽管了解丙型肝炎患者的临床和实验室检查情况，临床医生仍无法准确预测肝脏炎症分级和纤维化分期。肝活检是准确评估丙型肝炎患者肝脏疾病分级和分期的一项重要检查。
