The Royal Free Sheila Sherlock Liver Centre and Division of Surgery & Interventional Sciences, University College London, UK.
J Hepatol. 2013 May;58(5):962-8. doi: 10.1016/j.jhep.2012.12.016. Epub 2012 Dec 20.
BACKGROUND & AIMS: Histological assessment of fibrosis progression is currently performed by staging systems which are not continuous quantitative measurements. We aimed at assessing a quantitative measurement of fibrosis collagen proportionate area (CPA), to evaluate fibrosis progression and compare it to Ishak stage progression.
We studied a consecutive cohort of 155 patients with recurrent HCV hepatitis after liver transplantation (LT), who had liver biopsies at one year and were subsequently evaluated for progression of fibrosis using CPA and Ishak staging, and correlated with clinical decompensation. The upper quartile of distribution of fibrosis rates (difference in CPA or Ishak stage between paired biopsies) defined fast fibrosers.
Patients had 610 biopsies and a median follow-up of 116 (18-252) months. Decompensation occurred in 29 (18%) patients. Median Ishak stage progression rate was 0.42 units/year: (24 (15%) fast fibrosers). Median CPA fibrosis progression rate was 0.71%/year (36 (23%) fast fibrosers). Clinical decompensation was independently associated by Cox regression only with CPA (p=0.007), with AUROCs of 0.81 (95% CI 0.71-0.91) compared to 0.68 (95% CI 0.56-0.81) for Ishak stage. Fast fibrosis defined by CPA progression was independently associated with histological de novo hepatitis (OR: 3.77), older donor age (OR: 1.03) and non-use/discontinuation of azathioprine before 1 year post-LT (OR: 3.85), whereas when defined by Ishak progression, fast fibrosers was only associated with histological de novo hepatitis.
CPA fibrosis progression rate is a better predictor of clinical outcome than progression by Ishak stage. Histological de novo hepatitis, older donor age and non-use/discontinuation of azathioprine are associated with rapid fibrosis progression in recurrent HCV chronic hepatitis after liver transplantation.
目前，纤维化进展的组织学评估是通过分期系统进行的，而这些分期系统不是连续的定量测量。我们旨在评估纤维化胶原比例面积（CPA）的定量测量，以评估纤维化进展，并将其与 Ishak 分期进展进行比较。
我们研究了 155 例肝移植（LT）后复发性 HCV 肝炎患者的连续队列，这些患者在一年内进行了肝活检，并随后使用 CPA 和 Ishak 分期评估纤维化进展，并与临床失代偿相关。纤维化率分布的上四分位数（配对活检之间的 CPA 或 Ishak 分期差异）定义为快速纤维化者。
患者进行了 610 次活检，中位随访时间为 116（18-252）个月。29 例（18%）患者发生失代偿。Ishak 分期进展率中位数为 0.42 单位/年：（24 例快速纤维化者）。CPA 纤维化进展率中位数为 0.71%/年（36 例快速纤维化者）。Cox 回归分析仅独立地将临床失代偿与 CPA 相关（p=0.007），CPA 的 AUROC 为 0.81（95%CI 0.71-0.91），而 Ishak 分期为 0.68（95%CI 0.56-0.81）。CPA 进展定义的快速纤维化与组织学新发肝炎（OR：3.77）、供体年龄较大（OR：1.03）和 LT 后 1 年内未使用/停用硫唑嘌呤（OR：3.85）独立相关，而当以 Ishak 进展定义时，快速纤维化者仅与组织学新发肝炎相关。
CPA 纤维化进展率是预测临床结局的较好指标，优于 Ishak 分期的进展。肝移植后复发性 HCV 慢性肝炎中，组织学新发肝炎、供体年龄较大和未使用/停用硫唑嘌呤与快速纤维化进展相关。
