Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C
Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C
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DOI：
10.1136/jcp.54.6.461
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发表时间：
2001-06-01
影响因子：
3.4
通讯作者：
Record, CO
中科院分区：
文献类型：
--
作者：
Zaitoun, AM;Al Mardini, H;Record, CO
背景-肝纤维化是肝病的主要后果之一。一些慢性丙型肝炎和酒精性肝病(ALD)患者可同时出现纤维化和脂肪变性。目的：应用体视学和形态计量学技术对慢性丙型肝炎患者的肝纤维化和脂肪变性进行定量，并与酒精性肝病患者对照组进行比较。材料与方法：对86例慢性丙型肝炎患者和32例酒精性肝病患者(对照组)的肝组织进行体视学和形态计量学分析。采用苏木精-伊红染色和Picro-Mallory染色切片。用体视学方法评估肝纤维化、脂肪变性、实质和其他结构(胆管和中央静脉区)的面积分数(A(A))。结果慢性丙型肝炎患者与ALD患者肝纤维化的A(A)值有显著差异(平均(SD)：19.14(10.59)vs15.97(12.51))。慢性丙型肝炎患者门脉及门静脉周围(1区)纤维化程度明显高于对照组(P=0.00004)，平均(SD)为9.04(6.37vs3.59)。两组患者均出现中心周围纤维化(3区)，但ALD患者更为明显。这些结果与改进的Ishak评分系统有很好的相关性。然而，在慢性丙型肝炎合并肝硬变(6期)的患者中，纤维化的A(A)值在20%到74%之间。丙型肝炎患者脂肪小球直径明显小于酒精性肝病组(P=0.00002)。慢性丙型肝炎患者的微球比ALD患者更常见。在慢性丙型肝炎患者中，脂肪颗粒与脂肪变性相比呈带状分布。结论：定量体视学技术是评估慢性丙型肝炎肝纤维化和脂肪变性的简便、可靠的方法，对判断肝纤维化的来源、部位和分期最有价值。体视学和形态计量学被推荐用于纤维化和脂肪变性的定量，特别是用于评估慢性丙型肝炎患者的新治疗策略。
Backgrounds-Hepatic fibrosis is one of the main consequences of liver disease. Both fibrosis and steatosis may be seen in some patients with chronic hepatitis C and alcoholic liver disease (ALD).Aims-To quantitate fibrosis and steatosis by stereological and morphometric techniques in patients with chronic hepatitis C and compare the results with a control group of patients with ALD. In addition, to correlate the quantitative features of fibrosis with the Ishak modified histological score.Materials and methods-Needle liver biopsies from 86 patients with chronic hepatitis C and from 32 patients with alcoholic liver disease (disease controls) were analysed by stereological and morphometric analyses using the Prodit 5.2 system. Haematoxylin and eosin and Picro-Mallory stained sections were used. The area fractions (A(A)) of fibrosis, steatosis, parenchyma, and other structures (bile duct and central vein areas) were assessed by stereological method. The mean diameters of fat globules were determined by morphometric analysis.Results-Significant differences were found in the A(A) of fibrosis, including fibrosis within portal tract areas, between chronic hepatitis C patients and those with ALD (mean (SD): 19.14 (10.59) v 15.97 (12.51)). Portal and periportal (zone 1) fibrosis was significantly higher (p = 0.00004) in patients with chronic hepatitis C compared with the control group (mean (SD): 9.04 (6.37) v 3.59 (3.16)). Pericentral fibrosis (zone 3) occurred in both groups but was significantly more pronounced in patients with ALD. These results correlate well with the modified Ishak scoring system. However, in patients with cirrhosis (stage 6) with chronic hepatitis C the A(A)of fibrosis varied between 20% and 74%. The diameter of fat globules was significantly lower in patients with hepatitis C (p = 0.00002) than the ALD group (mean (SD): 14.44 (3.45) v 18.5 (3.32)). Microglobules were more frequent in patients with chronic hepatitis C than in patients with ALD. In patients with chronic hepatitis C, the fat globules had a zonal distribution in comparison with pan steatosis in ALD.Conclusion-Quantitative, stereological techniques are simple and reliable for evaluating hepatic fibrosis and steatosis in chronic hepatitis C. They are most useful for assessing the origin, location, and the stage of fibrosis. Stereology and morphometry are recommended for the quantitation of fibrosis and steatosis, particularly for the evaluation of new treatment strategies in patients chronic hepatitis C.