慢性肝炎的肝活检评估

Liver biopsy assessment in chronic hepatitis.

作者信息

Lefkowitch Jay H

机构信息

Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.

出版信息

Arch Med Res. 2007 Aug;38(6):634-43. doi: 10.1016/j.arcmed.2006.08.005.

DOI:10.1016/j.arcmed.2006.08.005

PMID:17613355

Abstract

Liver biopsy has been a major diagnostic tool in the evaluation of individuals with chronic hepatitis for many decades and remains the most direct way of visualizing hepatic necroinflammation and fibrosis. In chronic viral hepatitis B and C, immune attack on hepatocytes bearing viral antigens results in the entry of lymphocytes and other effector cells through the portal tracts from which other lesions may evolve, including interface and lobular hepatitis as well as fibrosis or cirrhosis. Classification systems have been developed in order to provide semiquantitative grading of necroinflammation and staging of fibrosis and include the Scheuer, Batts and Ludwig, Ishak, and METAVIR systems. This review provides an historical perspective on histopathological methods of analyzing chronic hepatitis, describes the essential criteria of each of the major scoring systems and discusses problems related to sampling error, observer variation, and specimen size.

摘要

几十年来，肝活检一直是评估慢性肝炎患者的主要诊断工具，并且仍然是观察肝脏坏死性炎症和纤维化的最直接方法。在慢性乙型和丙型病毒性肝炎中，对携带病毒抗原的肝细胞的免疫攻击导致淋巴细胞和其他效应细胞通过门静脉进入，其他病变可能由此演变而来，包括界面性肝炎和小叶性肝炎以及纤维化或肝硬化。为了对坏死性炎症进行半定量分级和对纤维化进行分期，已经开发了多种分类系统，包括Scheuer、Batts和Ludwig、Ishak以及METAVIR系统。本综述提供了分析慢性肝炎的组织病理学方法的历史视角，描述了每个主要评分系统的基本标准，并讨论了与抽样误差、观察者差异和标本大小相关的问题。