Chevallier M, Guerret S, Chossegros P, Gerard F, Grimaud J A
Unité de Pathologie Cellulaire, Institute Pasteur de Lyon, France.
Hepatology. 1994 Aug;20(2):349-55.
The evaluation of hepatic fibrosis on histological sections is of great interest for the staging and follow-up of chronic liver disease. Because no reliable scoring system is yet available, we have designed a semiquantitative scoring system in which the four main sites of fibrotic deposit--centrilobular vein, portal tract and perisinusoidal space, together with width and number of septa when present--are analyzed. These different items have been previously settled from comparison with morphometric measurements to evaluate surface density of total collagen performed on the same liver needle biopsy specimens stained with picro-sirius. The score has been tested on samples from 200 consecutive patients with various liver diseases and compared with the surface density of total collagen and Knodell scoring system. For observer variation study, the features by three independent pathologists were coded on 20 cases. There was a good interobserver (Kendall's tau-b = 0.75) and intraobserver (tau-B = 0.73) reproducibility. Each component of the fibrosis scoring system and total collagen surface density were significantly linearly related (one-way polynomial analysis, p < 10(-4); the correlation between semiquantitative scoring system and surface density of total collagen was 0.73 (p < 10(-5). Our semiquantitative scoring system, simple and reproducible, describes both liver architecture and fibrotic deposit. It is better related to morphometric measurement of fibrosis than each of its constituents or than the fibrosis item of the Knodell scoring system. It represents a reliable and convenient method for fibrosis evaluation, which is mandatory for clinical use.
肝纤维化组织切片评估对于慢性肝病的分期及随访具有重要意义。由于目前尚无可靠的评分系统，我们设计了一种半定量评分系统，该系统对纤维化沉积的四个主要部位——中央静脉、汇管区和窦周间隙，以及存在时的间隔宽度和数量进行分析。这些不同项目先前已通过与形态测量结果比较确定，以评估用苦味酸天狼星染色的同一肝穿刺活检标本上的总胶原蛋白表面密度。该评分系统已在连续200例患有各种肝病的患者样本上进行测试，并与总胶原蛋白表面密度和Knodell评分系统进行比较。为进行观察者间变异研究，由三位独立病理学家对20例病例的特征进行编码。观察者间（Kendall's tau - b = 0.75）和观察者内（tau - B = 0.73）的可重复性良好。纤维化评分系统的每个组成部分与总胶原蛋白表面密度均显著线性相关（单向多项式分析，p < 10(-4)）；半定量评分系统与总胶原蛋白表面密度之间的相关性为0.73（p < 10(-5)）。我们的半定量评分系统简单且可重复，既能描述肝脏结构又能描述纤维化沉积。与纤维化的形态测量相比，它比其各个组成部分或Knodell评分系统的纤维化项目表现更好。它代表了一种可靠且方便的纤维化评估方法，是临床应用所必需的。
