Yano M, Kumada H, Kage M, Ikeda K, Shimamatsu K, Inoue O, Hashimoto E, Lefkowitch J H, Ludwig J, Okuda K
Nagasaki Chuo National Institute for Clinical Research, Ohmura-shi, Japan.
Hepatology. 1996 Jun;23(6):1334-40. doi: 10.1002/hep.510230607.
Most patients infected with hepatitis C virus (HCV) develop chronic hepatitis. Unfortunately, the pathological evolution of this disease over time is not completely understood. We studied 70 HCV-positive patients, from whom 2 to 10 liver biopsy specimens (mean, 3.9) had been obtained during an interval of 1 to 26 years (mean, 8.8 years). Each biopsy specimen was evaluated independently by four pathologists who each provided a numerical score for the grade of portal/periportal necroinflammation (0-4), grade of lobular necroinflammation (0-4), their sum (final grade), and the stage of fibrosis (1-4). The scores were correlated with progression of disease, if any, and transition to cirrhosis. During follow-up, 35 patients (50%) developed cirrhosis. Cirrhosis developed in all patients with a high final grade (> or = 5) of necroinflammation on initial biopsy who were followed for 10 years and in 96% of patients with an intermediate final grade (3.5-4.9) who were followed for 17 years. Only 30.4% of patients with low final grade (< or = 3.4) on initial biopsy developed cirrhosis after 13 years. All patients with evidence of septal fibrosis with incomplete nodularity (stage 3.0-3.4) in the initial biopsy progressed to unequivocal cirrhosis by 10 years. The rate of progression to cirrhosis was accelerated in patients whose initial biopsies showed high-grade and -stage lesions. This study demonstrates the importance of grading and staging liver biopsy lesions in chronic hepatitis C, particularly for patients with high-grade necroinflammation, septal fibrosis, and regions of modularity on initial biopsy who are at high risk of developing advanced cirrhosis in the ensuing decade.
大多数丙型肝炎病毒（HCV）感染者会发展为慢性肝炎。不幸的是，这种疾病随时间的病理演变尚未完全明确。我们研究了70例HCV阳性患者，在1至26年（平均8.8年）的时间间隔内，从他们身上获取了2至10份肝活检标本（平均3.9份）。每份活检标本由四位病理学家独立评估，他们分别为门静脉/门静脉周围坏死性炎症分级（0 - 4级）、小叶坏死性炎症分级（0 - 4级）、二者之和（最终分级）以及纤维化分期（1 - 4期）提供一个数值评分。这些评分与疾病进展（如有）以及向肝硬化的转变相关。在随访期间，35例患者（50%）发展为肝硬化。初始活检时坏死性炎症最终分级高（≥5级）且随访10年的所有患者以及最终分级中等（3.5 - 4.9级）且随访17年的患者中，96%发展为肝硬化。初始活检时最终分级低（≤3.4级）的患者中，只有30.4%在13年后发展为肝硬化。初始活检显示有不完全结节性间隔纤维化（3.0 - 3.4期）证据的所有患者在10年内进展为明确的肝硬化。初始活检显示高级别和高分期病变的患者向肝硬化的进展速度加快。这项研究表明了对慢性丙型肝炎肝活检病变进行分级和分期的重要性，特别是对于初始活检时有高级别坏死性炎症、间隔纤维化和结节区域的患者，他们在随后十年中有发展为晚期肝硬化的高风险。
