The role of liver biopsy in chronic hepatitis C
The role of liver biopsy in chronic hepatitis C
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DOI：
10.1053/jhep.2002.36381
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发表时间：
2002-11-01
期刊：
影响因子：
13.5
通讯作者：
Dienstag, JL
中科院分区：
文献类型：
--
作者：
Dienstag, JL
1997年美国国立卫生研究院关于丙型肝炎的共识发展会议的报告认可了肝活检前的治疗。我们回顾了以下问题：肝脏组织学是否有助于确定抗病毒治疗的紧迫性并预测其反应的可能性，以及替代标记物能否取代组织学评估？由于慢性丙型肝炎的进展速度受基线组织学分级/阶段的影响，患者可以分为中到重度肝炎患者和轻度肝炎患者，前者需要立即治疗，后者可以推迟治疗，直到有更有效/可耐受的治疗方法可用。不太先进的基线组织学已被证明是抗病毒治疗反应性的独立预测因子。虽然活检的预测价值不足以阻止晚期纤维化患者的治疗，但基线活检有助于评估对治疗结果的预期。最近发表的报告表明，实验室标记物可以预测低级别纤维化和治疗之间的区别--表明间隔纤维化/肝硬变。然而，这些指标不足以预测纤维化/肝硬变患病率不同的人群中的组织学差异，也不足以提供除了广泛的定性差异之外的任何东西，远远不能提供肝脏活检的潜在信息。对于大多数患者来说，预肝活检的价值大于其风险，提供了有关治疗紧迫性的信息，应予以保留。确定组织学活动和分期的非侵入性实验室标志物，特别是疾病加速进展的遗传预测因子的研究，具有高度的优先地位。
The report of the 1997 National Institutes of Health Consensus Development Conference on hepatitis C endorsed pretreatment liver biopsy. We revisit the following questions: Does liver histology help determine the urgency of, and predict the likelihood of response to, antiviral therapy, and can surrogate markers supplant histological assessment? Because the rate of progression of chronic hepatitis C is influenced by baseline histological grade/stage, patients can be stratified into those with moderate to severe hepatitis, who merit imminent therapy, and those with mild hepatitis, in whom therapy can be postponed until more effective/tolerable treatments become available. Less advanced baseline histology has been shown to be an independent predictor of responsiveness to antiviral therapy. Although the predictive value of biopsy is insufficient to withhold therapy from patients with advanced fibrosis, baseline biopsy helps gauge expectations for the outcome of therapy. Reports have been published recently suggesting that laboratory markers can predict distinctions between low-grade fibrosis and therapy-indicating septal fibrosis/cirrhosis. These indices, however, are insufficiently reliable to predict histological distinctions in populations with varying prevalences of fibrosis/cirrhosis or to provide anything more than broad qualitative distinctions, far short of the potential information in a liver biopsy. For most patients, the value of pretreatment liver biopsy outweighs its risks, provides information about the urgency of treatment, and should be retained. Studies to identify noninvasive laboratory markers of histological activity and stage, especially genetic predictors of accelerated disease progression, command a high priority.