Department of Pathology, Hôpital Beaujon, University Paris-Denis Diderot, Paris, France.
Liver Int. 2015 Jan;35 Suppl 1:78-81. doi: 10.1111/liv.12710.
The end point of liver fibrosis in almost all chronic liver diseases including HBV chronic hepatitis is cirrhosis. Progression to cirrhosis is associated with annular deposition of fibrous tissue and vascular remodeling with a shift from a lobular to nodular organization. Although advanced liver fibrosis was previously thought to be irreversible, today there is compelling evidence that cirrhosis can be reversed if the underlying cause of liver injury is eliminated. Indeed, most clinical trials with antiviral therapy and histological follow-up have shown that fibrosis can regress and that in some cases even cirrhosis can reverse following long-term HBV-DNA suppression, although the return to a fully normal liver is rarely observed and difficult to prove. Nevertheless, a marked percentage of cirrhosis will not reverse even after effective antiviral therapy. Generally cirrhosis is more likely to regress if it is recent, there is effective and long-lasting viral suppression, an internal capacity to regenerate and no vascular thrombosis. HBV treatment in patients with cirrhosis is associated with an improved clinical outcome although there may still be a risk of hepatocellular carcinoma. Nevertheless it has not yet been determined if a favorable outcome depends on histological regression or whether the reversal of cirrhosis is merely a surrogate marker of viral suppression. The significance of the reversal of cirrhosis is still a subject of debate because neither the histological scoring systems nor non-invasive markers to evaluate the reversal of cirrhosis have been validated.
几乎所有慢性肝病，包括乙型肝炎慢性肝炎，肝纤维化的终点都是肝硬化。进展为肝硬化与纤维组织的环状沉积和血管重构有关，导致从小叶组织向结节组织转变。虽然以前认为晚期肝纤维化是不可逆转的，但现在有令人信服的证据表明，如果消除肝损伤的根本原因，肝硬化是可以逆转的。事实上，大多数抗病毒治疗和组织学随访的临床试验表明，纤维化可以消退，在某些情况下，即使在长期抑制乙型肝炎病毒 DNA 后，肝硬化也可以逆转，尽管很少观察到并难以证明肝脏完全恢复正常。然而，即使经过有效的抗病毒治疗，仍有相当一部分肝硬化不会逆转。一般来说，如果肝硬化是近期的、病毒抑制有效且持久、有内部再生能力且没有血管血栓形成，肝硬化更有可能逆转。虽然仍有肝细胞癌的风险，但肝硬化患者的 HBV 治疗与改善的临床结局相关。然而，尚不确定良好的结局是否取决于组织学缓解，或者肝硬化的逆转是否仅仅是病毒抑制的替代标志物。肝硬化逆转的意义仍存在争议，因为评估肝硬化逆转的组织学评分系统和非侵入性标志物尚未得到验证。
