Vaquer P, Canet R, Llompart A, Riera J, Obrador A, Gayá J
Department of Gastroenterology, Son Dureta Hospital, Palma de Mallorca, Spain.
Liver. 1994 Oct;14(5):265-9. doi: 10.1111/j.1600-0676.1994.tb00086.x.
We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positive to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver biopsies were carried out for each patient, with an interval ranging between 12 and 126 months (mean 50.2 +/- 30.7). In all cases the usual histological classification was applied and the histological activity index scoring system according to Knodell et al. was determined. Fifteen cases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patients (18.5%) in the second liver biopsy. Epidemiological, clinical, biochemical and histological progression and the group with impairment in liver histology. Factors related to histological worsening were: more advanced age (p = 0.002), high levels of aspartate aminotransferase (p = 0.04), high global histological activity index (p = 0.03) and piecemeal necrosis and bridging necrosis scores (p = 0.02) at first biopsy. The histological activity index can be applied to assess the natural history of chronic viral hepatitis, and is a good tool to evaluate the prognosis. Thus chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.
我们评估了29例未经治疗的慢性丙型肝炎患者肝脏疾病的组织学进展情况。所有患者通过酶联免疫吸附试验2（ELISA2）和重组免疫印迹法2（RIBA2）检测丙型肝炎病毒抗体均为阳性。每位患者均进行了两次肝活检，间隔时间为12至126个月（平均50.2±30.7个月）。所有病例均采用常规组织学分类，并根据克诺德尔等人的方法确定组织学活动指数评分系统。15例病情恶化（51.7%），12例无组织学变化（41.4%），2例病情改善（6.9%）。在第二次肝活检中，5例患者（18.5%）发现有肝硬化。对流行病学、临床、生化和组织学进展情况以及肝组织学受损组进行了研究。与组织学恶化相关的因素有：年龄较大（p = 0.002）、天冬氨酸转氨酶水平较高（p = 0.04）、首次活检时整体组织学活动指数较高（p = 0.03）以及碎片状坏死和桥接坏死评分较高（p = 0.02）。组织学活动指数可用于评估慢性病毒性肝炎的自然病程，是评估预后的良好工具。因此，至少在半数病例中，慢性丙型肝炎病毒感染是一种组织学上进行性发展的疾病。
