治疗时代病毒性肝炎纤维化的进展和退化：北京分类。

StephenW

Mod Pathol. 2018 Apr 26. doi: 10.1038/s41379-018-0048-0. [Epub ahead of print]
Progression and regression of fibrosis in viral hepatitis in the treatment era: the Beijing classification.
Theise ND1,2, Jia J3, Sun Y3, Wee A4, You H3.
Author information

1
    Department of Pathology, Mount Sinai Beth Israel Medical Center, New York, NY, USA. [email protected].
2
    Department of Pathology, New York University School of Medicine, New York, NY, USA. [email protected].
3
    Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
4
    Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore.

Abstract

In this new era of successful long term suppression of hepatitis B viral replication and consistent eradication of hepatitis C virus the necessity for routine pre-treatment biopsies has often been eliminated. Thus, whether there is utility to perform liver biopsy in chronic viral hepatitis is undergoing re-examination. In response to these changing needs, we have developed a new staging system, the Beijing Classification, for assessment of biopsy specimens from patients with chronic viral hepatitis. The most important novelty of the Beijing Classification is that it includes not only extent (stage) of fibrosis, but the quality of fibrosis, namely if the specimen shows predominantly regressive vs. progressive features (or is indeterminantly balanced between the two), the P-I-R score. This histologic distinction between regressive and progressive fibrosis, while invoked in this particular setting of chronic viral hepatitis, may have applicability to all forms of chronic liver disease. Thus, the review contains a description of the concepts of regression and progression with the aim of empowering pathologists to apply them in histopathologic-clinical correlation research as well as in the specific clinical setting for which it was developed. Also, in light of changing clinical needs, grading of necroinflammatory activity and staging of fibrosis are simplified into three point scales. These simplifications should aid the general diagnostic pathologist in being comfortable and confident in assessing biopsy specimens as the criteria for their distinction are far more precise, with significantly reduced "gray zones" of prior grading/staging systems.

StephenW

Mod Pathol。 2018年4月26日。doi：10.1038 / s41379-018-0048-0。 [电子版提前打印]
治疗时代病毒性肝炎纤维化的进展和退化：北京分类。
Theise ND1,2，Jia J3，Sun Y3，Wee A4，You H3。
作者信息

1
    美国纽约州西奈山Beth以色列医学中心病理学系。 [email protected]。
2
    纽约大学医学院病理系，美国纽约州纽约市。 [email protected]。
3
    首都医科大学附属北京友谊医院肝病研究中心，肝硬化转化医学北京市重点实验室，消化疾病国家临床研究中心，北京。
4
    新加坡国立大学医院，新加坡国立大学林咏林医学院病理学系。

抽象

在成功长期抑制乙型肝炎病毒复制和持续根除丙型肝炎病毒的新时代，常规治疗前活检的必要性经常被消除。因此，是否有效用于慢性病毒性肝炎的肝活检正在进行重新检查。针对这些不断变化的需求，我们开发了一种新的分期系统，即北京分类，用于评估慢性病毒性肝炎患者的活检标本。北京分类最重要的新颖之处在于它不仅包括纤维化的程度（阶段），还包括纤维化的质量，即如果标本主要表现出回归与进展特征（或两者之间不确定地平衡），PIR得分了。这种组织学上区分退行性进展性纤维化和慢性病毒性肝炎的特殊情况可能适用于所有形式的慢性肝病。因此，该综述包含了回归和进展的概念描述，目的是授权病理学家将其应用于组织病理学 - 临床相关性研究以及其开发的特定临床环境。此外，鉴于临床需求的变化，坏死性炎症活动的分级和纤维化分期被简化为三个等级。这些简化应该有助于一般诊断病理学家在评估活检标本时感到舒适和自信，因为它们的区分标准更为精确，显着减少了先前分级/分期系统的“灰色区域”。