治疗时代病毒性肝炎纤维化的进展和消退：北京分类

StephenW

Progression and regression of fibrosis in viral hepatitis in the treatment era: the Beijing classification

    Neil D. Theise, Jidong Jia, Yameng Sun, Aileen Wee & Hong You

Modern Pathologyvolume 31, pages1191–1200 (2018) | Download Citation
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

治疗时代病毒性肝炎纤维化的进展和消退：北京分类

    Neil D. Theise，Jidong Jia，Yameng Sun，Aileen Wee和Hong You

Modern Pathologyvolume 31，pages1191-1200（2018）|下载引文
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，常常消除了常规治疗前活组织检查的必要性。因此，在慢性病毒性肝炎中是否有用于进行肝活检的用途正在重新检查。为了满足这些不断变化的需求，我们开发了一种新的分期系统 - 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，即如果标本显示出主要的退行性与进行性特征（或两者之间不确定的平衡），PIR得分了。在慢性病毒性肝炎的这种特定环境中引用的回归性和进行性纤维化的这种组织学区别可能适用于所有形式的慢性肝病。因此，该评价包含对回归和进展概念的描述，目的是使病理学家能够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中。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的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组织检查标本时感到舒适和自信，因为它们的区别标准要精确得多，并且显着减少了先前分级/分期系统的“灰色区域”。