肝活检样本的图像分析可测量纤维化并预测临床结果。
Image analysis of liver biopsy samples measures fibrosis and predicts clinical outcome.
机构信息
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
Department of Anatomical Pathology, PathWest, QEII Medical Centre, Perth, Australia.
出版信息
J Hepatol. 2014 Jul;61(1):22-7. doi: 10.1016/j.jhep.2014.02.031. Epub 2014 Mar 6.
BACKGROUND & AIMS: Histopathological scoring of liver fibrosis mainly measures architectural abnormalities and requires a minimum biopsy size (⩾ 10 mm). Liver collagen quantification may allow use of small size biopsies and improve the prediction of clinical outcomes. This study evaluated the ability of the collagen proportional area (CPA) measurement to predict clinical outcomes.
METHODS
Clinical outcomes were determined using population based data-linkage for chronic hepatitis C (CHC) patients from 1992 to 2012. Quantitative digital image analysis of liver biopsies was used for CPA measurement.
RESULTS
533 patients with a biopsy size ⩾ 5 mm were included. Median follow up was 10.5 years. 26 developed hepatocellular carcinoma (HCC), 39 developed liver decompensation and 33 had liver related death. 453 had Metavir F0-F2 and 80 had F3-F4. CPA ranged from 1.3% to 44.6%. CPA and Metavir stage were independently associated with liver related death. Metavir stage, CPA stage and age were independently associated with HCC. CPA stage (C1: 0%-5%, C2: 5%-10%, C3: 10%-20%, C4: >20%) stratified risk and a significant difference in outcomes was present between all CPA stages for HCC and between C2-C3 and C3-C4 for decompensation and liver related death. The 15 year composite endpoint-free survival was 97% for C1, 89% for C2, 60% for C3, 7% for C4. C4 had significantly worse survival than ⩽ C3 (p<0.001) in cirrhotic patients.
CONCLUSIONS
CPA stage gave additional information regarding risk stratification for adverse clinical outcomes independent of Metavir stage.
背景与目的
肝纤维化的组织病理学评分主要测量结构异常，需要最小活检大小（≥10mm）。肝胶原定量可能允许使用小尺寸活检，并改善对临床结果的预测。本研究评估了胶原比例面积（CPA）测量预测临床结果的能力。
方法
使用 1992 年至 2012 年基于人群的慢性丙型肝炎（CHC）患者数据链接来确定临床结果。使用定量数字图像分析对肝活检进行 CPA 测量。
结果
纳入了 533 名活检大小≥5mm的患者。中位随访时间为 10.5 年。26 例发生肝细胞癌（HCC），39 例发生肝失代偿，33 例发生与肝脏相关的死亡。453 例 Metavir F0-F2，80 例 F3-F4。CPA 范围为 1.3%-44.6%。CPA 和 Metavir 分期与肝相关死亡独立相关。Metavir 分期、CPA 分期和年龄与 HCC 独立相关。CPA 分期（C1：0%-5%，C2：5%-10%，C3：10%-20%，C4：>20%）分层风险，HCC 和失代偿与肝相关死亡的所有 CPA 分期之间均存在显著差异。15 年复合终点无事件生存率为 C1 组 97%，C2 组 89%，C3 组 60%，C4 组 7%。C4 组在肝硬化患者中的生存率明显低于≤C3 组（p<0.001）。
结论
CPA 分期提供了关于不良临床结果风险分层的额外信息，独立于 Metavir 分期。
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