Kleiner David E
Laboratory of Pathology, National Cancer Institute, Bldg. 10/Room 2N212, Bethesda, MD 20892, USA.
Semin Liver Dis. 2005 Feb;25(1):52-64. doi: 10.1055/s-2005-864781.
The liver biopsy has long been the gold standard for the evaluation of the state of liver disease in patients with chronic hepatitis C. Although a liver biopsy continues to be a recommended part of the work-up of this disease, its routine use is challenged by the increasing effectiveness of therapy and by surrogate biochemical tests that give information about the stage of disease. Nevertheless, recent studies have shown that histological features other than stage may have predictive value for disease progression and therapeutic response to interferon-based regimens. Pathologists can increase the relevance and utility of the liver biopsy in chronic hepatitis C by the systematic reporting of steatosis and iron accumulation in addition to stage and grade, and by identifying certain potential confounding liver diseases, such as steatohepatitis and hereditary hemochromatosis. Clinicians can then make best use of the information derived from the liver biopsy to help them advise patients on the natural history of their disease and the therapeutic options that are available.
长期以来，肝活检一直是评估慢性丙型肝炎患者肝脏疾病状态的金标准。尽管肝活检仍是该疾病检查工作中推荐的一部分，但其常规应用受到治疗效果不断提高以及能提供疾病阶段信息的替代生化检测的挑战。然而，最近的研究表明，除了疾病阶段外，其他组织学特征可能对疾病进展和基于干扰素方案的治疗反应具有预测价值。病理学家可以通过除了报告疾病阶段和分级外，系统地报告脂肪变性和铁沉积情况，并识别某些潜在的混淆性肝脏疾病，如脂肪性肝炎和遗传性血色素沉着症，来提高肝活检在慢性丙型肝炎中的相关性和实用性。临床医生随后可以充分利用从肝活检中获得的信息，帮助他们就患者疾病的自然史和可用的治疗选择向患者提供建议。
