Department of Pathology Indiana University School of Medicine, Indianapolis, IN.
Adv Anat Pathol. 2021 Nov 1;28(6):408-414. doi: 10.1097/PAP.0000000000000312.
Fibrosis is not a unidirectional, linear process, but a dynamic one resulting from an interplay of fibrogenesis and fibrolysis depending on the extent and severity of a biologic insult, or lack thereof. Regression of fibrosis has been documented best in patients treated with phlebotomies for hemochromatosis, and after successful suppression and eradication of chronic hepatitis B and C infections. This evidence mandates a reconsideration of the term "cirrhosis," which implies an inevitable progression towards liver failure. Furthermore, it also necessitates a staging system that acknowledges the bidirectional nature of evolution of fibrosis, and has the ability to predict if the disease process is progressing or regressing. The Beijing classification attempts to fill this gap in contemporary practice. It is based on microscopic features termed "the hepatic repair complex," defined originally by Wanless and colleagues. The elements of the hepatic repair complex represent the 3 processes of fragmentation and regression of scar, vascular remodeling (resolution), and parenchymal regeneration. However, regression of fibrosis does not imply resolution of cirrhosis, which is more than just a stage of fibrosis. So far, there is little to no evidence to suggest that large regions of parenchymal extinction can be repopulated by regenerating hepatocytes. Similarly, the vascular lesions of cirrhosis persist, and there is no evidence of complete return to normal microcirculation in cirrhotic livers. In addition, the risk of hepatocellular carcinoma is higher compared with the general population and these patients need continued screening and surveillance.
纤维化不是一个单向的、线性的过程，而是一个动态的过程，取决于生物损伤的程度和严重程度，由纤维化和纤维溶解的相互作用产生。纤维化的消退在接受放血疗法治疗血色素沉着症的患者以及慢性乙型和丙型肝炎感染成功抑制和消除后得到了最好的证明。这一证据要求重新考虑“肝硬化”一词，因为它暗示着向肝功能衰竭的不可避免进展。此外，还需要一个分期系统来承认纤维化演变的双向性质，并能够预测疾病过程是在进展还是在消退。北京分类试图填补当代实践中的这一空白。它基于最初由 Wanless 及其同事定义的称为“肝修复复合体”的微观特征。肝修复复合体的要素代表了瘢痕的碎裂和消退、血管重塑（消退）和实质再生这 3 个过程。然而，纤维化的消退并不意味着肝硬化的消退，肝硬化不仅仅是纤维化的一个阶段。到目前为止，几乎没有证据表明实质消失的大片区域可以被再生的肝细胞重新填充。同样，肝硬化的血管病变仍然存在，没有证据表明肝硬化肝脏的微循环可以完全恢复正常。此外，与一般人群相比，这些患者患肝细胞癌的风险更高，需要持续的筛查和监测。
