Quantitative assessment of fibrosis and steatosis in liver biopsies from patients with chronic hepatitis C

Backgrounds-Hepatic fibrosis is one of the main consequences of liver disea se. Both fibrosis and steatosis may be seen in some patients with chronic h epatitis C and alcoholic liver disease (ALD). Aims-To quantitate fibrosis and steatosis by stereological and morphometric techniques in patients with chronic hepatitis C and compare the results wi th a control group of patients with ALD. In addition, to correlate the quan titative features of fibrosis with the Ishak modified histological score. Materials and methods-Needle liver biopsies from 86 patients with chronic h epatitis C and from 32 patients with alcoholic liver disease (disease contr ols) were analysed by stereological and morphometric analyses using the Pro dit 5.2 system. Haematoxylin and eosin and Picro-Mallory stained sections w ere used. The area fractions (A(A)) of fibrosis, steatosis, parenchyma, and other structures (bile duct and central vein areas) were assessed by stere ological method. The mean diameters of fat globules were determined by morp hometric analysis. Results-Significant differences were found in the A(A) of fibrosis, includi ng fibrosis within portal tract areas, between chronic hepatitis C patients and those with ALD (mean (SD): 19.14 (10.59) v 15.97 (12.51)). Portal and periportal (zone 1) fibrosis was significantly higher (p = 0.00004) in pati ents with chronic hepatitis C compared with the control group (mean (SD): 9 .04 (6.37) v 3.59 (3.16)). Pericentral fibrosis (zone 3) occurred in both g roups but was significantly more pronounced in patients with ALD. These res ults correlate well with the modified Ishak scoring system. However, in pat ients with cirrhosis (stage 6) with chronic hepatitis C the A(A)of fibrosis varied between 20% and 74%. The diameter of fat globules was significantly lower in patients with hepatitis C (p = 0.00002) than the ALD group (mean (SD): 14.44 (3.45) v 18.5 (3.32)). Microglobules were more frequent in pati ents with chronic hepatitis C than in patients with ALD. In patients with c hronic hepatitis C, the fat globules had a zonal distribution in comparison with pan steatosis in ALD. Conclusion-Quantitative, stereological techniques are simple and reliable f or evaluating hepatic fibrosis and steatosis in chronic hepatitis C. They a re most useful for assessing the origin, location, and the stage of fibrosi s. Stereology and morphometry are recommended for the quantitation of fibro sis and steatosis, particularly for the evaluation of new treatment strateg ies in patients chronic hepatitis C.