单位：[1]Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China临床科室国家中心肝病分中心首都医科大学附属北京友谊医院[2]Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China[3]Infectious Department, Affiliated Hospital of Yanbian University, Yanji, China[4]Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China[5]Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China[6]Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing, China首都医科大学附属天坛医院[7]Hepatology Institute, Peking University People’s Hospital, Beijing, China[8]Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China[9]Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China[10]Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing, China[11]Department of Infectious Disease, the Fifth Hospital of Shijiazhuang City, Shijiazhuang, China[12]Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People’s Armed Police Force, Tianjin, China[13]Department of Gastroenterology and Hepatology, Beijing Youan HospitalCapital Medical University, Beijing, China[14]Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China[15]Department of Pathology, China-Japan Friendship Hospital, Beijing, China[16]Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore[17]Departments of Pathology and Medicine (Division of Digestive Diseases), Mount Sinai Beth Israel Medical Center, New York, NY.
Liver fibrosis is the net result of dynamic changes between fibrogenesis and fibrolysis. Evidence has shown that antiviral therapy can reverse liver fibrosis or even early cirrhosis caused by hepatitis B virus. However, current evaluation systems mainly focus on the severity of, but not the dynamic changes in, fibrosis. Here, we propose a new classification to evaluate the dynamic changes in the quality of fibrosis, namely: predominantly progressive (thick/broad/loose/pale septa with inflammation); predominately regressive (delicate/thin/dense/splitting septa); and indeterminate, which displayed an overall balance between progressive and regressive scarring. Then, we used this classification to evaluate 71 paired liver biopsies of chronic hepatitis B patients before and after entecavir-based therapy for 78 weeks. Progressive, indeterminate, and regressive were observed in 58%, 29%, and 13% of patients before treatment versus in 11%, 11%, and 78% after treatment. Of the 55 patients who showed predominantly regressive changes on posttreatment liver biopsy, 29 cases (53%) had fibrosis improvement of at least one Ishak stage, and, more interestingly, 25 cases (45%) had significant improvement in terms of Laennec substage, collagen percentage area, and liver stiffness despite remaining in the same Ishak stage. Conclusion: This new classification highlights the importance of assessing and identifying the dynamic changes in the quality of fibrosis, especially relevant in the era of antiviral therapy.
基金：
National Science and Technology Major Project [2013ZX10002004]; National Key Technologies RD ProgramNational Key Technology R&D Program [2015BAI13B09]
第一作者单位：[1]Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China
通讯作者：
通讯机构：[1]Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China[17]Departments of Pathology and Medicine (Division of Digestive Diseases), Mount Sinai Beth Israel Medical Center, New York, NY.[*1]Departments of Pathology and Medicine (Division of Digestive Diseases), Mount Sinai Beth Israel Medical Center First Avenue at 16th Street New York NY 10003[*2]Liver Research Center, Beijing Friendship Hospital Capital Medical University 95 Yong-an Road Xi-Cheng District Beijing 100050, China[*3]Liver Research Center, Beijing Friendship Hospital, Capital Medical University 95 Yong-an Road Xi-Cheng District Beijing 100050, China
推荐引用方式(GB/T 7714)：
Sun Yameng,Zhou Jialing,Wang Lin,et al.New Classification of Liver Biopsy Assessment for Fibrosis in Chronic Hepatitis B Patients Before and After Treatment[J].HEPATOLOGY.2017,65(5):1438-1450.doi:10.1002/hep.29009.
APA：
Sun, Yameng,Zhou, Jialing,Wang, Lin,Wu, Xiaoning,Chen, Yongpeng...&Jia, Jidong.(2017).New Classification of Liver Biopsy Assessment for Fibrosis in Chronic Hepatitis B Patients Before and After Treatment.HEPATOLOGY,65,(5)
MLA：
Sun, Yameng,et al."New Classification of Liver Biopsy Assessment for Fibrosis in Chronic Hepatitis B Patients Before and After Treatment".HEPATOLOGY 65..5(2017):1438-1450
医学