Stănculeţ N, Grigoraş Adriana, Predescu O, Floarea-Strat Alina, Luca Cătălina, Manciuc Carmen, Dorobăţ Carmen, Căruntu Irina Draga
Discipline of Histology, Grigore T. Popa University of Medicine and Pharmacy, Iassy, Romania.
Rom J Morphol Embryol. 2012;53(1):81-7.
Starting from the quantification of the specific lesions for chronic hepatitis B and C, our study focused on (i) the correspondence between the necroinflammatory activity and the fibrosis stage ascertained through the Ishak scoring system, (ii) the classification overlaps and differences of Ishak vs. METAVIR score. The study group consisted of 202 cases with chronic hepatitis B and 751 cases with chronic hepatitis C, diagnosed based on liver biopsies. The fragments of hepatic tissue were routinely processed and stained with Hematoxylin-Eosin, trichrome Szekely, Gordon-Sweet silver impregnation, and Periodic Acid-Schiff. A semiquantitative evaluation was performed using the Ishak (for hepatitis B and C) and the METAVIR (for hepatitis C) scoring systems. Our results revealed that the comparison between hepatitis B and C, based on the necroinflammatory activity and fibrosis, is able to offer through the numeric values of the Ishak scoring system accurate proofs, which support the aggressivity of hepatitis C, because it develops fibrosis more quickly, even on the background of mild necroinflammatory activity. Also, our data showed that the necroinflammatory activity and the fibrosis are not processes which progress in a consistent pattern. The application of the METAVIR scoring system for the cases with chronic hepatitis C confirmed that there is not a direct correlation between necroinflammation and fibrosis. The Ishak scoring system provides through the wide range of numeric values attributed for the evaluation of necroinflammatory activity and fibrosis far more precise criteria for the appraisal of the degree of damage to the hepatic parenchyma at the time of the diagnosis. Supplementary, the METAVIR scoring system allows for the hepatitis C an assessment of the entire histologic activity, including the interface hepatitis and the associated lobular necrosis components. The scoring systems have unavoidably strengths and weaknesses, but the choice of a specific one must reflect the consensus between the pathologists and the clinicians, relying on their experience.
从对慢性乙型和丙型肝炎特定病变的量化入手，我们的研究聚焦于：（i）通过伊沙克评分系统确定的坏死性炎症活动与纤维化阶段之间的对应关系；（ii）伊沙克评分与梅塔维（METAVIR）评分的分类重叠及差异。研究组由202例慢性乙型肝炎患者和751例慢性丙型肝炎患者组成，均基于肝活检确诊。肝组织切片常规处理后，用苏木精 - 伊红、三色塞克利、戈登 - 斯威特银浸染及过碘酸 - 希夫染色。使用伊沙克评分系统（用于乙型和丙型肝炎）和梅塔维评分系统（用于丙型肝炎）进行半定量评估。我们的结果显示，基于坏死性炎症活动和纤维化对乙型和丙型肝炎进行比较，通过伊沙克评分系统的数值能够提供准确证据，支持丙型肝炎的侵袭性，因为即使在轻度坏死性炎症活动背景下，丙型肝炎纤维化进展也更快。此外，我们的数据表明，坏死性炎症活动和纤维化并非以一致模式进展。对慢性丙型肝炎病例应用梅塔维评分系统证实，坏死性炎症与纤维化之间不存在直接关联。伊沙克评分系统通过为评估坏死性炎症活动和纤维化赋予的广泛数值范围，为诊断时肝实质损伤程度的评估提供了更为精确的标准。此外，梅塔维评分系统可对丙型肝炎的整个组织学活动进行评估，包括界面性肝炎及相关小叶坏死成分。评分系统不可避免地各有优缺点，但具体选择必须反映病理学家和临床医生之间基于经验的共识。
