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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 11, s. 1025 - 1030 |
Importance of Liver Biopsy in Chronic Hepatitis C Virus Infection Urbánek P.1, Vedralová J.2, Mareček Z.1, Brodanová M.3, Procházková-Francisci E.4, Brůha R.1, Petrtýl J.1, Kaláb M.1 1IV. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta doc. MUDr. A. Žák, CSc. 2Hlavův patologicko anatomický ústav 1. lékařské fakulty UK, Praha, přednosta prof.MUDr. C. Povýšil, DrSc. 3I. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. P. Klener, DrSc. 4Laboratoř Aliatros při Mikrobiologickém ústavu 1. lékařské fakulty UK, Praha, vedoucí lékař MUDr. E. Procházková-Francisci |
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Summary: Introduction: The importance of liver biopsy and knowledge of the histological activity of liver les
on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts
to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial
question in patients with chronic HCV infection is to differentiate patients with already developed
liver cirrhosis from those with chronic hepatitis. Objectives: 1. To evaluate the impact of the
calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in
the histological assessment.2. To assess the correlation of prediction of cirrhosis liver based on
clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected
histological findings not correlating with the clinical picture. Group of patients: The group was
formed by 139 patients. In all patients during the baseline examination the patient’s history data
were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on
laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore
agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC
values was assessed. Results: 1. Based on calculation of DSC it is possible to predict accurately
the existence of cirrhosis of the liver or chronic hepatitis only in 31 % patients. In 69 % patients
even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the
hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction.
In 8 % patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5 %
patients cirrhosis of the liver was not confirmed despite the presence of clinical signs.3. The
frequency of other histological findings participating in the development of the hepatic lesion in
chronic HCV infection was minimal. In the authors´ group as such only steatosis and toxic
damage of hepatic tissue by alcohol were identified. These findings were, however, suspected
already before biopsy. Steatosis can be however considered also a manifestation of HCV infection.
Conclusion: The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection. The
investigation was supported by IGA grant NI-6015/00
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