慢性乙型肝炎患者抗病毒治疗后肝纤维化的定性病理评估

StephenW

Zhonghua Gan Zang Bing Za Zhi. 2017 Nov 20;25(11):819-826. doi: 10.3760/cma.j.issn.1007-3418.2017.11.005.
[Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B]. [Article in Chinese;  Abstract available in Chinese from the publisher]
Sun YM1, Zhou JL1, Wang L1, Wu XN1, Chen YP2, Piao HX3, Lu LG4, Jiang W5, Xu YQ6, Feng B7, Nan YM8, Xie W9, Chen GF10, Zheng HW11, Li H12, Ding HG13, Liu H14, Lyu FD14, Shao C14, Wang TL15, Ou XJ1, Wang BQ1, Chen SY1, You H1, Jia JD1.
Author information
1Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.2Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.3Infectious Department, Affiliated Hospital of Yanbian University, Yanji 133000, China.4Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.5Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.6Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.7Hepatology Institute, Peking University People's Hospital, Beijing 100044, China.8Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.9Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.10Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing 100039, China.11Department of Infectious Disease, the Fifth Hospital of Shijiazhuang City, Shijiazhuang 050024, China.12Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People's Armed Police Force, Tianjin 300161, China.13Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.14Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.15Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China.

Abstractin                                English, Chinese
目的： 抗病毒治疗可以逆转部分乙型肝炎纤维化和肝硬化，但既往有关肝纤维化逆转的研究多采用病理半定量方法，而非定性评估。本研究旨在建立反映慢性乙型肝炎（CHB）抗病毒治疗后肝纤维化/肝硬化动态变化的病理定性评估方法。 方法： 入组CHB肝纤维化及肝硬化初治患者，以恩替卡韦为基础的抗病毒治疗前及治疗78周后行两次肝穿刺活组织学检查，每半年进行1次随访评估。根据不同纤维间隔所占比例，提出评估肝纤维化动态变化的定性新标准（P-I-R分类）：进展为主型（predominantly Progressive），逆转为主型（predominantly Regressive）和不确定型（Indeterminate），分别使用此分类标准和Ishak纤维化分期评估治疗前后纤维化变化，使用Ishak炎症活动度评分评估治疗前后炎症活动度变化。 结果： 共入组112例有治疗前后两次肝穿刺的CHB患者，其中71例Ishak≥3期且肝穿刺质量合格的患者纳入最终分析。根据P-I-R分类，治疗前，进展为主型、不确定型和逆转为主型患者比例分别为58%（41/71）、29%（21/71）和13%（9/71），三种类型间丙氨酸氨基转移酶、天冬氨酸氨基转移酶、白蛋白、HBeAg阳性率、HBV DNA和肝脏硬度值比较，差异有统计学意义（P < 0.05）；而治疗后，进展为主型、不确定型和逆转为主型患者比例变为11%（8/71）、11%（8/71）和78%（55/71）。在35例治疗前后Ishak分期无变化的患者中，72%（25/35）的患者治疗后P-I-R评分为逆转为主型，且这些患者的Laennec评分、胶原比例面积和肝脏硬度值治疗后均较治疗前有所下降。 结论： 新的P-I-R分类可用于评估CHB患者抗病毒治疗后肝纤维化的动态变化。.


KEYWORDS: Anti-viral therapy; Ishak score; Liver fibrosis; Qualitative histological assessment

PMID:29325275