Vallet-Pichard Anaïs, Pol Stanislas, Mallet Vincent
Institut Cochin, université Paris-Descartes (UMR-S1016), CNRS (UMR 8104), Paris, France.
Rev Prat. 2011 Jan;61(1):39-43.
The evaluation of liver fibrosis in chronic viral hepatitis is of paramount importance since secondary complications, including hepatocellular carcinoma, occur in patients with extensive fibrosis and cirrhosis. Clinical examination and some simple biological and morphological tests represent the first step to appraise liver fibrosis in viral hepatitis. Biochemical (Fibrotest, Hepascore, Fibrometre) or morphological (Fibroscan) methods have emerged over the past ten years to avoid--in more than half of patients--the systematic use of the liver biopsy to appraise liver fibrosis in chronic hepatitis C virus infection. The liver biopsy remains however essential in many situations--especially for demonstrating regression of cirrhosis after viral inactivation. Regression of cirrhosis is now a recognized concept, thanks to the next generation of antiviral treatments. Today, the inactivation of viral hepatitis is an achievable primary goal and regression of cirrhosis becomes a reasonable secondary goal.
评估慢性病毒性肝炎中的肝纤维化至关重要，因为包括肝细胞癌在内的继发性并发症会发生在广泛纤维化和肝硬化患者身上。临床检查以及一些简单的生物学和形态学检测是评估病毒性肝炎肝纤维化的第一步。在过去十年中，出现了生化方法（Fibrotest、Hepascore、Fibrometre）或形态学方法（Fibroscan），以便在超过半数的患者中避免在评估丙型肝炎病毒慢性感染时系统性地使用肝活检来评估肝纤维化。然而，在许多情况下，肝活检仍然必不可少——尤其是用于证明病毒失活后肝硬化的消退。由于新一代抗病毒治疗，肝硬化的消退现在是一个公认的概念。如今，使病毒性肝炎失活是一个可以实现的首要目标，而肝硬化的消退则成为一个合理的次要目标。
