Progression of fibrosis in chronic hepatitis C
Progression of fibrosis in chronic hepatitis C
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DOI：
10.1053/gast.2003.50018
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发表时间：
2003-01-01
期刊：
影响因子：
29.4
通讯作者：
Hoofnagle, JH
中科院分区：
文献类型：
--
作者：
Ghany, MG;Kleiner, DE;Hoofnagle, JH
背景和目标：纤维化是肝硬化的标志，其恶化可能是慢性肝病进展的最佳替代标志。我们使用肝组织学评估了一个大型慢性丙型肝炎（CHC）患者队列，以评估纤维化进展的发生率和预测因素。研究方法：该队列包括123例CHC患者，他们接受了2次肝活检，间隔4-212个月（平均44个月），未进行干预治疗。使用组织学活动指数（评分，0-18）对肝脏组织学进行分级，并使用0（无纤维化）至6（肝硬化）的评分系统对纤维化进行分期。结果：在123例患者中，48例（39%）纤维化评分显示进展，46例（37%）无变化，29例（24%）显示改善。在纤维化恶化的患者中，75%的患者评分增加1分，25%的患者评分增加2分或更多，39%的患者进展为肝硬化。总体进展率为每年0.12个纤维化单位，如果进展呈线性，则该速率预测50年内进展为肝硬化。肝纤维化进展率是可变的，在年龄较大的患者、血清丙氨酸和天冬氨酸转氨酶水平较高的患者以及初始肝活检时门静脉周围坏死最广泛的患者中，肝纤维化进展率较高。结论：CHC中纤维化进展的最佳预测因子是血清转氨酶升高的程度和肝活检中肝细胞坏死和炎症的程度。这些发现支持转氨酶水平正常和轻度肝组织学的患者可以安全地推迟治疗的建议。
Background & Aims: Fibrosis is the hallmark of hepatic cirrhosis, worsening of which is probably the best surrogate marker for progression of chronic liver disease. We evaluated a large cohort of patients with chronic hepatitis C (CHC) using liver histology to assess the rate and predictors of progression of fibrosis. Methods: The cohort consisted of 123 patients with CHC who underwent 2 liver biopsies 4-212 months (mean, 44 months) apart without intervening treatment. Liver histology was graded using the histology activity index (score, 0-18) and fibrosis staged using a scoring system of 0 (no fibrosis) to 6 (cirrhosis). Results: Among 123 patients, 48 (39%) showed progression in fibrosis scores, 46 (37%) showed no change, and 29 (24%) showed improvement. Of those with worsening fibrosis, 75% had a 1-point increase and 25% a 2-point or greater increase in scores, and 39% showed progression to cirrhosis. The overall rate of progression was 0.12 fibrosis units per year, a rate that predicts progression to cirrhosis in 50 years if progression was linear. The rate of fibrosis progression was variable, and it was higher among older patients, those with higher serum alanine and aspartate aminotransferase levels, and those with the most extensive periportal necrosis on initial liver biopsy. Conclusions: The best predictors of fibrosis progression in CHC are the extent of serum aminotransferase elevations and the degree of hepatocellular necrosis and inflammation on liver biopsy. These findings support the recommendation that patients with normal aminotransferase levels and mild liver histology can safely defer treatment.