atitis activity index scoring system 14 and others, [15][16][17] have To clarify the characteristics of fibrosis developed in been used in the assessment of the degree of fibrosis, howthe process from chronic hepatitis C to cirrhosis, a morever, these methods cannot completely avoid the observer's phometric analysis of liver biopsy samples was conbias. In the present study, we selected chronic hepatitis C ducted on 25 chronic hepatitis C patients and 20 chronic patients who developed cirrhosis and underwent multiple hepatitis B patients (controls). Hepatitis C patients were liver biopsy procedures; and conducted a quantitative analyfollowed up for 3 to 23 years. The mean number of liver sis using morphometry to determine chronological changes biopsies performed on these patients was 3.8. Each biof fibrosis in the course from chronic hepatitis to cirrhosis. opsy was evaluated for the degree of fibrosis by using
The result of the initial biopsy was also assessed as to two methods: a semiquantitative method with a staging whether it could be a predictive factor for the development scoring system, and morphometry using a computed imof cirrhosis from chronic hepatitis C. age analysis system. A significant correlation was observed between the Stage and the area of fibrosis (AF ร
PATIENTS AND METHODS
the ratio of the area of fibrosis to that of the entire tissue specimen). The AF in cirrhosis was significantly higher
We examined 25 patients with chronic hepatitis C who were positive for hepatitis C virus antibodies by a second generation assay, in hepatitis C patients than in hepatitis B patients. The negative to hepatitis B surface antigen, and eventually developed ratio of AF in the last biopsy sample to AF in the initial cirrhosis during clinical observation. They were selected from ap-
biopsy sample was significantly higher in hepatitis C
proximately 1,000 patients with chronic liver diseases seen at Napatients than in hepatitis B patients. Evolution from tional Nagasaki Chuo Hospital, Ohmura, Japan during the period chronic hepatitis C to cirrhosis occurred more frefrom 1967 to 1994. They were willing to undergo biopsy procedures quently in patients aged ยข50 years, and this time period and to be followed up at a regular interval because of fluctuations was 1.8 times shorter than that in patients aged รต50 in their serum alanine aminotransferase levels. The initial biopsy years. AF in the initial biopsy related significantly to the was usually undertaken within 6 months after the disease onset. period of evolution from chronic hepatitis C to cirrhosis. Patients, whose initial biopsy showed cirrhosis, were excluded from the study. Ten of the 25 patients had received blood transfusions, AF in the initial biopsy might be a predictive factor for and three of them were followed up after having developed acute prognosis. (HEPATOLOGY 1997;25:1028-1031.) hepatitis after transfusion. Development of cirrhosis was diagnosed based on biopsy findings and clinical findings including those of laparoscopy. Liver biopsy was performed repeatedly in 11 patients even Abbreviation: AF, area of fibrosis.