慢性肝病和肝纤维化 北京肝病医院哪家好讲解.ppt

慢性肝病和肝纤维化 北京武警总队第三医院肝病诊疗中心 Hepatic Fibrosis is the Livers Wound Healing Response to Many Chronic Injuries FIBROSIS Inherited Metabolic Disorders Excess Vitamin A Cholestatic Disorders Immune Disorders Drugs Hepatitis Viruses Alcohol NASH Chronic Liver Disease Chronic hepatitis with fibrosis 10-50 yrs Cirrhosis Normal liver Hepatocellular Carcinoma Liver Transplant 0 1 2 3 4 0 10 20 30 40 50 F METAVIR Duration in years Rapid Intermediate Slow fibroser Poynard et al. Lancet 1997; 349: 825 N=1157 Progression of Liver Fibrosis in HCV Sampling error of liver biopsy Fibrosis area: 55% Fibrosis area: 13% modified from M. Pinzani, Florence Ultrasonic transducer axis Vibrator Probe Ribs Liver Hepatic elasticity measurement (Fibroscan) Liver sample The scanned volume represents 1/ 500 of the whole liver D e p t h ( m m ) Time (ms) (a) F0 0 20 40 60 10 20 30 40 50 60 % -5 0 5 D e p t h ( m m ) Time (ms) (b) F2 0 20 40 60 10 20 30 40 50 60 % -5 0 5 D e p t h ( m m ) Time (ms) (c) F4 0 20 40 60 10 20 30 40 50 60 % -5 0 5 D e p t h ( m m ) D e p t h ( m m ) D e p t h ( m m ) Hepatic elasticity measurement (Fibroscan) 1 10 100 F0 F1 F2 F3 F4 Fibrosis Stage S t i f f n e s s ( k P a ) L o g a r i t h m i c s c a l e Patient distribution 5 22 17 14 9 Sandrin L et al., Ultrasound Med. Biol. 200 Discriminative power of hepatic elasticity measurements Patients with chronic hepatitis C Hepatic Stellate cells - Perisinusoidal cells of Normal Liver Friedman and Arthur, Science Medicine, 2002 Hepatic Stellate cell Activation - A Central Event in Liver Fibrosis Normal Liver Activated HSC with Fibrosis Friedman SL and Arthur, Science and Medicine , 2002 Cirrhosis is Reversible! Evidence in: HBV HCV Secondary biliary cirrhosis AIH PBC Wilsons disease Thalassemia after bone marrow xplant Animal models Cirrhosi