Jármay K, Karácsony G, Ozsvár Z, Nagy I, Schaff Z, Lonovics J
I. Belgyógyászati Klinika, Szent-Györgyi Albert Orvostudományi Egyetem, Szeged.
Orv Hetil. 1998 Aug 16;139(33):1955-60.
BACKGROUND/AIMS: Hepatitis C virus (HCV) infection is one of the most important diseases with high chronicity rate (50-80%) leading to end-stag cirrhosis and hepatocellular carcinoma. Hepatic histology shows a characteristic but not diagnostic picture. The aim of this study was to evaluate the characteristic histological findings in correlation with epidemiological features in our liver biopsy material.
PATIENTS/METHODS: 106 liver biopsies were studid between 1993-1996. All patients (60 males, 46 females, age between 11-81 years, mean age: 43 years) were found to be positive for HCV antibody by a second-generation ELISA method. The biopsy materials were fixed in buffered formalin and having embedded in paraffin, stained with hematoxylin and eosin, periodic acid-Schiff after diastase digestion, Gömöri's reticulin stain and picrosirius red for collagen. The histological evaluation was based upon the new classification of chronic hepatitis proposed by Desmet et al. The statistical analysis was performed by the Chi square test.
Minimal chronic hepatitis (HAI: 1-3) was found in 14 (13.2%), mild chronic hepatitis (HAI: 4-8) in 69 (65.09%) and moderate chronic hepatitis (HAI: 9-12) in 23 (21.69%) cases, while assessment of fibrosis (staging) resulted fibrosis 0/1 in 44 (41.5%), fibrosis 2 in 14 (13.2%), fibrosis 3 in 37 (34.9%) and cirrhosis (fibrosis 4) in 11 (10.37%) cases. Among histological features of chronic hepatitis C, the frequency of steatosis (70.75%), lymphoid F/A (63.2%), and bile duct lesions (12.26%) have paralelly increased with activity (grade) of hepatitis and these changes were more pronounced in moderate chronic hepatitis (p < 0.001).
More than half of chronic hepatitis C patients presented mild histological lesions with stage 1 fibrosis. Lymphoid F/A, bile duct damage and steatosis are important diagnostic features that show a strong correlation with the activity of chronic hepatitis. The assessment of fibrosis (stage: 3 and stage: 4) in mild chronic hepatitis cases does alert the hepatologist to perform the liver biopsy to detect the fibrotic changes in chronic hepatitis C.
背景/目的：丙型肝炎病毒（HCV）感染是最重要的疾病之一，其慢性化率高（50 - 80%），可导致终末期肝硬化和肝细胞癌。肝脏组织学表现具有特征性但并非诊断性特征。本研究旨在评估我们肝活检材料中特征性组织学发现与流行病学特征的相关性。
患者/方法：1993 - 1996年间对106例肝活检进行了研究。所有患者（60例男性，46例女性，年龄在11 - 81岁之间，平均年龄：43岁）通过第二代酶联免疫吸附测定法检测HCV抗体均为阳性。活检材料用缓冲福尔马林固定，石蜡包埋，苏木精和伊红染色，淀粉酶消化后过碘酸 - 希夫染色，吉姆萨网状纤维染色以及用苦味酸天狼星红染色检测胶原。组织学评估基于德斯梅特等人提出的慢性肝炎新分类。采用卡方检验进行统计分析。
14例（13.2%）为轻度慢性肝炎（组织学活动指数：1 - 3），69例（65.09%）为轻度慢性肝炎（组织学活动指数：4 - 8），23例（21.69%）为中度慢性肝炎（组织学活动指数：9 - 12），而纤维化评估（分期）结果为44例（41.5%）纤维化0/1期，14例（13.2%）纤维化2期，37例（34.9%）纤维化3期，11例（10.37%）为肝硬化（纤维化4期）。在慢性丙型肝炎的组织学特征中，脂肪变性（70.75%）、淋巴细胞/汇管区（63.2%）和胆管病变（12.26%）的发生率随肝炎活动度（分级）平行增加，且这些变化在中度慢性肝炎中更为明显（p < 0.001）。
超过一半的慢性丙型肝炎患者呈现轻度组织学病变伴1期纤维化。淋巴细胞/汇管区、胆管损伤和脂肪变性是重要的诊断特征，与慢性肝炎活动度密切相关。对轻度慢性肝炎病例的纤维化评估（3期和4期）确实提醒肝病学家进行肝活检以检测慢性丙型肝炎中的纤维化变化。
