治疗前后慢性乙型肝炎患者纤维化肝活检评估新分类

StephenW

Viral Hepatitis
New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment
Authors

    First published: 22 March 2017Full publication history
    DOI: 10.1002/hep.29009  View/save citation
    Cited by (CrossRef): 1 article Check for updates

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    Funding Information

    Potential conflict of interest: Dr. Theise consults for and received grants from Histoindex.

    Supported by National Science and Technology Major Project (2013ZX10002004) and National Key Technologies R&D Program (2015BAI13B09).

    See Editorial on Page 1432

Abstract

Liver fibrosis is the net result of dynamic changes between fibrogenesis and fibrolysis. Evidence has shown that antiviral therapy can reverse liver fibrosis or even early cirrhosis caused by hepatitis B virus. However, current evaluation systems mainly focus on the severity of, but not the dynamic changes in, fibrosis. Here, we propose a new classification to evaluate the dynamic changes in the quality of fibrosis, namely: predominantly progressive (thick/broad/loose/pale septa with inflammation); predominately regressive (delicate/thin/dense/splitting septa); and indeterminate, which displayed an overall balance between progressive and regressive scarring. Then, we used this classification to evaluate 71 paired liver biopsies of chronic hepatitis B patients before and after entecavir-based therapy for 78 weeks. Progressive, indeterminate, and regressive were observed in 58%, 29%, and 13% of patients before treatment versus in 11%, 11%, and 78% after treatment. Of the 55 patients who showed predominantly regressive changes on posttreatment liver biopsy, 29 cases (53%) had fibrosis improvement of at least one Ishak stage, and, more interestingly, 25 cases (45%) had significant improvement in terms of Laennec substage, collagen percentage area, and liver stiffness despite remaining in the same Ishak stage. Conclusion: This new classification highlights the importance of assessing and identifying the dynamic changes in the quality of fibrosis, especially relevant in the era of antiviral therapy.(Hepatology 2017;65:1438-1450)

StephenW

病毒性肝炎
治疗前后慢性乙型肝炎患者纤维化肝活检评估新分类
作者

    首次发布：2017年3月22日全面的出版历史
    DOI：10.1002 / hep.29009查看/保存引用
    引用（CrossRef）：1文章检查更新

    文章的高分为1分
    资金信息

    潜在的利益冲突：Theise博士咨询Histoindex并获得赠款。

    由国家科技重大专项（2013ZX10002004）和国家重点技术研发计划（2015BAI13B09）支持。

    见第1432页的编辑

抽象

肝纤维化是纤维发生和纤维化之间动态变化的最终结果。证据表明，抗病毒治疗可以逆转肝纤维化甚至乙肝病毒引起的早期肝硬化。然而，目前的评估系统主要集中在纤维化的严重性，而不是动态变化。在这里，我们提出一个新的分类来评估纤维化质量的动态变化，即：主要是进行性的（厚/宽/宽/松散/有炎症的苍白隔膜）;主要回归（细腻/细/密/分裂隔膜）;并且不确定，显示进行性和退行性瘢痕形成之间的整体平衡。然后，我们使用这种分类来评估78例慢性乙型肝炎患者在恩替卡韦治疗前后的71次配对肝活组织检查。 58％，29％和13％的患者在治疗前均观察到进行性，不确定性和回归性，而治疗后为11％，11％和78％。在治疗肝活检中主要呈倒退变化的55例患者中，29例（53％）至少有一个Ishak阶段纤维化改善，更有趣的是，25例（45％）在Laennec分期术中有显着改善，胶原蛋白百分比面积和肝硬度，尽管保持在相同的Ishak阶段。结论：这一新分类突显了评估和鉴定纤维化质量的动态变化的重要性，特别是在抗病毒治疗时代尤其如此（Hepatology 2017; 65：1438-1450）