Banner B F, Barton A L, Cable E E, Smith L, Bonkovsky H L
Department of Pathology, University of Massachusetts Medical Center, Worcester, USA.
Mod Pathol. 1995 Apr;8(3):232-8.
The Knodell score is inaccurate at predicting response to interferon alpha (IFN-alpha) therapy in patients with hepatitis C. Our aim was to see if specific histologic parameters, including iron deposition in liver biopsies, are better predictors of response to IFN-alpha than the total Knodell score. Thirty-five unselected patients were studied who had hepatitis C treated with IFN-alpha between 1990 and 1993, and pretreatment serum iron indices and liver needle biopsies performed. Biopsies were divided for light microscopy and quantitative iron determination. H&E-stained slides were graded for components I, II, III, IV, and total Knodell score. Quantitative determinations were percentage of portal triads with inflammation, piecemeal necrosis, lymphoid aggregates, and inflamed bile ducts; percentage of lobules with inflammation or acidophilic bodies; and percentage of triads with positive iron stain. Complete responders (CR) to IFN-alpha were defined by normalization of serum alanine aminotransferase (< or = 40 IU/liter), and noncomplete responders (NCR) by partial or no response. Data were analyzed statistically. CR had < 40% of triads positive for iron (P = 0.02) and lower serum ferritin (P = 0.05) and higher scores for lobular necrosis (P = 0.04). The percentage of iron-positive triads correlated only with cirrhosis. Addition of cirrhosis to percentage of iron-positive triads did not improve the predictive power of the portal iron. CR and NCR did not differ with respect to total Knodell score or any of the other individual parameters except Knodell II.
(a) Individual features of lobular necrosis and iron staining in portal triads are better predictors of response to IFN-alpha than the total Knodell score.(ABSTRACT TRUNCATED AT 250 WORDS)
Knodell评分在预测丙型肝炎患者对干扰素α（IFN-α）治疗的反应方面并不准确。我们的目的是探讨特定的组织学参数，包括肝活检中的铁沉积，是否比Knodell总分更能预测对IFN-α的反应。对1990年至1993年间接受IFN-α治疗的35例未经挑选的丙型肝炎患者进行了研究，并进行了治疗前血清铁指标检测和肝穿刺活检。活检组织分为两部分，分别用于光学显微镜检查和铁定量测定。对苏木精-伊红（H&E）染色的切片进行I、II、III、IV组分及Knodell总分的分级。定量测定包括有炎症、桥接坏死、淋巴滤泡和炎症胆管的门管区百分比；有炎症或嗜酸性小体的小叶百分比；以及铁染色阳性的门管区百分比。IFN-α完全缓解者（CR）定义为血清丙氨酸转氨酶恢复正常（≤40 IU/L），不完全缓解者（NCR）定义为部分缓解或未缓解。对数据进行统计学分析。CR组铁染色阳性的门管区比例<40%（P = 0.02），血清铁蛋白较低（P = 0.05），小叶坏死评分较高（P = 0.04）。铁染色阳性门管区比例仅与肝硬化相关。将肝硬化因素加入铁染色阳性门管区比例并不能提高门管区铁指标的预测能力。除Knodell II外，CR组和NCR组在Knodell总分或其他任何单个参数方面均无差异。
（a）小叶坏死和门管区铁染色的个体特征比Knodell总分更能预测对IFN-α的反应。（摘要截短至250字）
