The application of a numerical scoring system for evaluating the histological outcome in patients with chronic hepatitis B followed in long-term.
A numerical scoring system was applied and compared with conventional histological classification to assess the histological outcome in 42 patients with chronic hepatitis B followed for 16 to 162 months (mean = 75 months). Four histological categories in the biopsies were assessed and scored: (i) piecemeal necrosis; (ii) lobular necrosis; (iii) portal inflammation, and (iv) fibrosis and cirrhosis. The sum of all four categories was defined as the "Histological Activity Index." Altogether, 102 liver specimens, including 2 to 4 repeats from each patient, were investigated. A good correlation was noted between a high value of the Histological Activity Index score and several liver histology as monitored by conventional terminology for chronic hepatitis. Among patients with HBeAg persistence, 8 of 14 (57%) deteriorated during follow-up as judged by an increase in the Histological Activity Index score compared to 3 of 13 (23%) of the patients with HBeAg seroconversion (0.5 less than p less than 0.1). Piecemeal necrosis has been postulated to be a predictive marker for the eventual development of cirrhosis. Here, we found that a low score for piecemeal necrosis in the initial liver biopsy was significantly less predictive of a high fibrosis score in the follow-up biopsy than was a high score for initial piecemeal necrosis (p less than 0.001). It is concluded that the scoring system used can be applied to monitor the histological long-term follow-up, especially when separated into its four constituent categories. It also offers a means of predicting a chronic hepatitis outcome.
Lindh
G
G
Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, Stockholm, Sweden.
Weiland
O
O
Glaumann
H
H
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000473:pathology*; D006513:Hepatitis B e Antigens / Q000032:analysis; D006521:Hepatitis, Chronic / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D009336:Necrosis; D013997:Time Factors
D006513:Hepatitis B e Antigens