[Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital].
BACKGROUND
Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated.


METHODS
We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels.


RESULTS
A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage < 2. The histological results were as follows: G0 in 2%, G1 in 26.8%, G2 in 47.7%, G3 in 22.2% and G4 in 1.3%; stage of fibrosis was F0 in 7.2%, F1 in 30.1%, F2 in 37.9%, F3 in 19.6%, and F4 in 5.2%. Fibrosis was advanced (F >= 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels.


CONCLUSIONS
Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach.
Ubiña Aznar
E
E
Servicio de Aparato Digestivo, Hospital Costa del Sol, Marbella, Málaga, Spain.
Méndez Sánchez
I
I
Rivera Irigoin
R
R
Vera Rivero
F
F
Fernández Moreno
N
N
García Fernández
G
G
Navarro Jarabo
J M
JM
Fernández Pérez
F
F
Moreno Mejías
P
P
Pérez Aisa
A
A
Sánchez Cántos
A
A
D000328:Adult; D001707:Biopsy, Needle; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000821:virology; D006767:Hospitals, District; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies