Applicability and prognostic value of histologic scoring systems in primary sclerosing cholangitis
Applicability and prognostic value of histologic scoring systems in primary sclerosing cholangitis
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DOI：
10.1016/j.jhep.2015.06.008
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发表时间：
2015-11-01
影响因子：
25.7
通讯作者：
Ponsioen, Cyriel Y.
中科院分区：
文献类型：
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作者：
de Vries, Elisabeth M. G.;Verheij, Joanne;Ponsioen, Cyriel Y.
背景与目的：原发性硬化性胆管炎（PSC）是一种慢性胆汁淤积性肝病。目前，没有合适的组织学评分系统可用于PSC，评估坏死炎症活动程度（分级）和纤维化程度（分期）。本研究的目的是评估，如果三个评分系统，通常用于不同的肝脏疾病可以应用于分级和/或分期的PSC.Methods：64 PSC患者从荷兰队列，谁接受诊断性肝活检，包括在内。使用Ishak、Nakanuma和Ludwig系统对分期进行评分。使用Ishak和Nakanuma系统评分。定义了三种结局指标：无移植存活率、肝移植时间（LTx）和肝硬化相关症状（CRS）的发生率。使用Kaplan-Meier对数秩检验和考克斯回归分析评估分级和分期与结局的相关性。与生化指标的相关性通过斯皮尔曼等级检验进行评估。结果：Ishak、Nakanuma和Ludwig分期系统测量的疾病分期与无移植生存率的结果之间存在强相关性（风险比（HR）2.56; 95% CI 1.11-5.89，HR 6.53; 95% CI 2.01-21.22，HR 1.94; 95% CI 1.00-3.79）和至LTx的时间（HR 4.18; 95% CI 1.51-11.56，HR 7.05; 95% CI 1.77-28.11，HR 3.13; 95% CI 1.42-6.87）。Ishak和Nakanuma分级系统与CRS无关。组织病理学和肝生化之间的弱相关性showed.Conclusion：应用Nakanuma，Ishak和Ludwig组织病理学分期系统是可行的和临床相关的无移植生存和时间LTx。这表明这些分期系统可能是PSC临床试验中替代终点和分层目的的候选者。(C)2015年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. At present, there is no appropriate histologic scoring system available for PSC, evaluating both degree of necroinflammatory activity (grade) and fibrosis (stage). The aim of this study was to assess if three scoring systems, commonly used in different liver diseases could be applied for grading and/or staging of PSC.Methods: Sixty-four PSC patients from a Dutch cohort, who underwent diagnostic liver biopsy, were included. Staging was scored using Ishak, Nakanuma, and Ludwig systems. Grading was scored using Ishak and Nakanuma systems. Three measures of outcome were defined; transplant-free survival, time to liver transplantation (LTx) and occurrence of cirrhosis related symptoms (CRS). Association of grade and stage with outcome was estimated using Kaplan-Meier log-rank test, and Cox regression analysis. Correlation with biochemistry was assessed by Spearman's rank test.Results: There were strong associations between disease stage measured by Ishak, Nakanuma, and Ludwig staging systems with both outcome measuring transplant-free survival (Hazard ratio (HR) 2.56; 95% CI 1.11-5.89, HR 6.53; 95% CI 2.01-21.22, HR 1.94; 95% CI 1.00-3.79, respectively), and time to LTx (HR 4.18; 95% CI 1.51-11.56, HR 7.05; 95% CI 1.77-28.11, HR 3.13; 95% CI 1.42-6.87, respectively). Ishak and Nakanuma grading systems were not associated with CRS. Weak correlations between histopathology and liver biochemistry were shown.Conclusion: Applying the Nakanuma, Ishak, and Ludwig histopathological staging systems is feasible and clinically relevant given their association with transplant-free survival and time to LTx. This suggests that these staging systems could be likely candidates for surrogate endpoints and stratification purposes in clinical trials in PSC. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.