慢性HBV感染肝脏病理变化和生化ALT及病毒学关系

目的 探讨慢性HBV感染ALT、HBV DNA与肝脏病理的关系.方法 对81例慢性HBV感染患者检测血清ALT、HBV DNA.并进行肝活检病理检查.结果 肝脏炎症分级和纤维化分期与ALT明显相关(r值分别为0.683和0.419),与HBV DNA无相关性.随着肝脏炎症活动度和纤维化程度的加重,ALT有升高趋势(χ2趋势值分别为25.81和12.012),HBV DNA无升高趋势,而随着HBVDNA的升高,肝脏炎症活动度和纤维化程度并无加重趋势.肝组织HBsAg、HBcAg阳性组与阴性组的ALT、HBV DNA差异无统计学意义.结论 ALT与肝脏炎症活动度有明显相关性,仍是观察炎症变化的敏感指标,HBV DNA与肝组织炎症分级及纤维化分期无相关性.     

MR弥散加权成像评价肝纤维化的初步实验研究

目的使用实验性兔肝纤维化模型探讨MR弥散加权成像(DWI)评价肝纤维化的能力。方法5只对照组兔和22只实验组兔进行DWI检查。兔肝纤维化模型使用腹腔注射CCl4诱导建立。根据病理组织学检查结果,所有动物肝脏纤维化分期为S0～S4,肝脏炎症活动度分级为G0～G4。DWI使用b值为600s/mm2,测量DWI图像信号强度值(SI)、表观弥散系数(ADC)和指数表观弥散系数(EADC),比较不同肝纤维化分期和不同肝炎症活动度分级时平均SI、ADC和EADC值变化。结果随肝纤维化分期进展,SI和EADC值逐渐升高、ADC值逐渐下降(P<0.05);随炎症活动度分级增加,SI值逐渐升高,ADC值和EADC值波动式下降和升高(P<0.05)。结论随肝纤维化分期和炎症活动度分级进展,SI和EADC上升,ADC下降。初步研究结果显示,DWI对于全面评价肝纤维化时肝纤维化分期和炎症活动度分级有重要价值。     

67例慢性丙型肝炎治疗过程及随访中血清ALT、病毒载量及肝纤维化指标的变化

目的 观察聚乙二醇干扰素α-2b联合利巴韦林治疗慢性丙型肝炎过程中肝功能、病毒复制及肝纤维化指标的改变情况.方法 检测67例慢性丙型肝炎患者在干扰素联合利巴韦林治疗开始（0周）、结束（48周）和停药12周（60周）时血清丙氨酸转氨酶（ALT）、丙肝病毒核糖核酸（HCV RNA）、透明质酸（HA）、Ⅲ型前胶原肽（PCⅢ）、Ⅳ型胶原（Ⅳ-C）和层粘连蛋白（LN）水平.结果 治疗后完全应答组（CR-S,43/67） ALT、HCV RNA及血清4项纤维化指标均显著下降（P ＜0.05或P＜0.01）,部分应答组（CR-R,13/67）和无应答组（NR,11/67） ALT、HCV RNA及血清4项纤维化指标变化不明显,反跳甚至更高.结论 聚乙二醇干扰素α-2b联合利巴韦林治疗慢性丙型肝炎约65％患者完全应答,随着肝细胞炎症的改善,病毒RNA滴度、肝纤维化指标水平明显下降,表明干扰素联合利巴韦林能抑制HCV RNA复制,调节机体免疫功能,减轻肝脏炎症反应,改善肝功能,减少肝纤维化.     

慢性乙型肝炎患者肝组织中HBV抗原表达特征及其临床意义

目的探讨慢性乙型病毒性肝炎肝活检组织中检测乙肝表面抗原(HBsAg)和乙肝核心抗原(HBcAg)表达强度及表达方式的必要性。方法采用EnVision免疫组织化学法检测196例慢性乙型肝炎患者肝穿组织中HBsAg和HBcAg的表达水平,并用荧光定量PCR检测其血清中的HBV DNA的含量。对肝组织进行炎症活动度分级和纤维化分期。结果肝组织中的HBsAg表达强度和表达方式与炎症分级、纤维化分期和血清乙肝病毒载量均无相关性(P>0.05)。HBcAg表达强度与炎症分级无相关性(r=-0.02,P>0.05);与纤维化分期呈负相关(r=-0.28,P<0.01);与血清乙肝病毒载量呈正相关(r=0.53,P<0.01)。HBcAg表达方式与炎症分级为负相关(r=-0.27,P<0.01),其中浆型组炎症活动度分级高于核型组和混合型组(P<0.01),混合型组高于核型组(P<0.01)。HBcAg表达方式与纤维化分期亦呈较弱的负相关(r=-0.23,P<0.01),其中浆型组纤维化分期高于核型组和混合型组(P<0.05)。HBcAg表达方式与血清乙肝病毒载量呈正相关(r=0.22,P<0.01)。结论区分肝组织中的HBsAg表达强度和表达方式无益于了解慢性乙型肝炎患者肝损害的程度,而检测肝组织中的HBcAg则有助于临床抗病毒治疗。     

慢性乙型肝炎患者血清透明质酸、Ⅲ型前胶原水平与病理分级分期的关系

目的探讨慢性乙型肝炎患者血清HA、PCm水平与肝组织病理炎症分级纤维化分期的关系。方法采用放射免疫法检测111例慢性乙型肝炎患者血清HA、PCⅢ水平,并与肝组织病理炎症分级和纤维化分期结果相比较。结果血清HA、PCⅢ水平随着肝脏病理炎症活动及纤维化程度加重而增高。结论联合检测血清HA、PCⅢ水平是反映肝脏炎症和纤维化的良好指标。     

血清标志物联合超声指标诊断肝纤维化的临床研究

目的探讨血清肝纤维化标志物和超声结合对肝纤维化的诊断价值。方法检测100例慢性乙型肝炎或肝硬化患者8项超声指标和6项肝纤维化相关血清学指标,并与其病理检查结果进行相关分析。结果经过筛选,血小板衍生生长因子-BB(PDGF-BB) 透明质酸(HA) 肝实质回声(LPEC) 脾长径(SL)诊断S2以上纤维化的Se、Spe最高,为90.7%、85.4%。结论血清学和超声优势指标组合能提高诊断的灵敏度和特异度,优于单项或多项血清学和超声指标,是诊断肝纤维化较好的无创性方法。     

CHB患者血清25(OH)D3水平与肝脏炎症活动度及纤维化程度的相关性分析

目的 分析慢性乙型肝炎(chronic hepatitis B,CHB)炎症活动度及肝纤维化程度与血清25羟维生素D3[25(OH)D3]水平的相关性.方法 分析本院2018年5月至2020年4月收治的153例CHB患者的临床资料,检测其肝纤维化标志物透明质酸(hualuronic acid,HA)、层黏连蛋白(laminin,LN)、Ⅲ型前胶原(procollagenⅢ,PCⅢ)、IV型胶原(collage typeⅣ,CIV),对患者的肝纤维化进行分期(SO～S4期),按照患者炎症活动度与肝纤维化程度分组,检测血清25(OH)D3并比较分析.采用Pearson分析患者血清25(OH)D3与炎症活动度及肝纤维化的相关性.结果 患者血清25(OH)D3水平指标随着炎症活动度升高而呈现下降趋势,不同炎症活动度患者的血清25(OH)D3水平差异具有统计学意义(P<0.05);肝纤维化指标HA、LN、PCIII、与CIV随着肝纤维化程度水平升高,随着肝纤维化程度升高患者血清25(OH)D3水平降低,差异具有统计学意义(P<0.05);血清25(OH)D3水平与CHB炎症活动度(r=-0.772)、肝纤维化程度(r=-0.727)均显著相关(P<0.05).结论 CHB患者血清25(OH)D3水平与炎症活动度及肝纤维化程度呈负相关,25(OH)D3水平降低提示患者体内炎症活动加剧、肝纤维化程度加重.     

HBV基因型及肝脏组织学对聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎疗效的影响

目的 探讨聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎的疗效及HBV基因型和肝脏组织学对HBeAg血清学转换的影响.方法 54例经肝活检证实的、基因型明确的HBeAg阳性慢性乙型肝炎(CHB)患者根据体质量分别皮下注射聚乙二醇干扰素α-2a 135 μg或180 μg,或者聚乙二醇干扰素α-2b 50 μg、80 μg或者100 μg,每周一次,疗程为48周,停药后随访24周.治疗结束后统计HBeAg的血清学转换情况,分析HBV基因型及肝脏组织学对e抗原血清学转换的影响.结果 54例患者随访结束时HBeAg血清学转换率为29.63％ (16/54).基因B型患者HBeAg血清学转换率为35.29％,高于C型患者的27.03％,但差异无统计学意义(x2=0.382,P=0.537).肝脏炎症活动度较高者(＞G2)、纤维化程度较重者(＞S1)HBeAg血清学转换率较高(50.00％ vs.25.00％,40.90％ vs.21.88％),但均无统计学意义(x2=1.391、1.444,P=0.238、0.229).经多变量Logistic回归分析显示HBV基因型、肝脏炎症活动度、肝脏纤维化程度等诸因素中,仅肝脏炎症活动度为HBeAg血清学转换的重要影响因素.结论 肝脏炎症活动度是聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎疗效的重要影响因素,而HBV基因型和肝脏纤维化程度可能意义不大.     

乙型肝炎组织COX-2和ICAM-1表达与组织学分级的相关性

研究表明，COX-2及ICAM-1在慢性肝病的发生发展中起重要作用，并且与炎症活动及纤维化程度有关，但COX-2及ICAM-1表达与肝炎组织学分级之间的确切关系还不清楚。因此，本研究目的是通过肝穿刺及肝活检标本COX-2，ICAM-1的表达情况探讨二者与肝脏炎症活动度及纤维化程度的关系。     

慢性乙型肝炎患者肝功能及血清HBeAg和HBV DNA载量与肝组织病理相关性的研究

目的 探讨慢性乙型肝炎患者肝功能、HBeAg及HBV DNA水平与肝组织病理炎症分级和纤维化分期的关系.方法 选择233例慢性乙型肝炎患者进行肝穿病理学检查,同时所有患者检测HBV DNA、HBeAg及肝功能,比较患者的肝功能、HBeAg及HBV DNA水平在不同病理炎症分级及纤维化分期中的差异情况.结果 不同的炎症分级患者中,ALT以C3组最高,G0～1组最低,各组间比较差异有统计学意义(P =0.016);TBil以G4组最高,G0～1组最低,各组间比较差异有统计学意义(P=0.000);HBV DNA载量各组间差异无统计学意义.不同的纤维化分期患者中,ALT各组间比较差异无统计学意义;TBil以S4组最高,S2组最低,各组间比较差异有统计学意义(P=0.039);HBV DNA载量各组间差异无统计学意义.炎症分级为G3～4的患者比例在HBeAg阳性组与阴性组差异无统计学意义.纤维化分期S3～4的患者比例在HBeAS阳性组(38%)比HBeAg阴性组(53%)低,两组差异有统计学意义(P=0.025).结论 慢性乙型肝炎患者血清HBV DNA水平的高低不能反映其肝脏炎症及纤维化程度,HBeAg阴性慢乙肝患者肝组织纤维化程度较高,TBil水平与肝组织炎症分级及纤维化分期均有良好的相关性,ALT水平与炎症分级有一定的关联性,但与纤维化分期无关.     

儿童慢性乙肝肝组织病理与相关标志物的研究

目的 分析乙肝病毒核内共价闭合环状DNA（HBV cccDNA）、肝纤维化血清标志物、乙肝病毒基因型与肝脏纤维化和炎症活动度的相关性,以了解其在乙肝诊断中的价值,指导治疗和预后.方法 2008年4月至2011年8月于甘肃省人民医院儿科和兰州大学第一医院感染科门诊就诊和住院的乙肝及HBV携带患儿为慢性乙肝组和HBV携带组,选择同期健康查体儿童为对照组.检测慢性乙肝组、HBV携带组和对照组血清HA、LN、PCⅢ和CⅣ.依据病情严重程度,慢性乙肝组进一步分为轻度、中度和重度亚组;慢性乙肝组和HBV携带组检测血清HBV cccDNA和HBV基因型;分析HBV cccDNA、肝纤维化血清标志物、HBV基因型与肝脏纤维化和炎症活动度的相关性.结果 46例患儿进入分析,男34例,女12例,年龄1～16岁,平均年龄（11.8±3.7）岁.HBV携带组20例,慢性乙肝组26例（轻度13例、中度8例、重度5例）,对照组20例.①随乙肝临床分度加重,血清HA、LN、PCⅢ和CⅣ呈升高趋势,以重度乙肝亚组上升最为明显;②随肝组织纤维化程度与炎症活动度的增加,血清HA、LN、PCⅢ和CⅣ呈升高趋势;③血清HBV cccDNA阳性组与阴性组在肝组织炎症活动度〈G2级比例的差异无统计学意义（29/35 vs 9/11,P=0.963）;在肝组织纤维化〈S2期比例的差异无统计学意义（31/35 vs 9/11,P=0.736）;④HBV B基因型患儿肝炎症活动度和纤维化程度显著高于C基因型.结论 血清HBV cccDNA水平与肝纤维化和炎症活动度无相关性;血清HA、LN、PCⅢ和CⅣ,HBV基因型与肝纤维化和炎症活动度有较好的相关性.临床可结合病毒复制水平、丙氨酸氨基转移酶、肝纤维化血清标志物及HBV基因分型综合判断肝损害程度.     

慢性HBV感染者肝组织中BMP-7的表达与炎症纤维化的关系

目的研究慢性乙型肝炎病毒（HBV）感染者肝组织中骨形态发生蛋白7（BMP-7）表达与肝纤维化和炎症关系,初步探讨BMP-7慢性肝炎肝纤维化发生过程中可能发挥的作用。方法对81例慢性HBV感染者肝组织进行常规组织学观察,按病理肝纤维化和炎症分级进行分组。其中炎症GO级8例,G1级14例,G2级19例,G3级22例,G4级18例;纤维化SO级8例,S1级16例,S2级21例,S3级24例,S4级12例。肝组织进行BMP-7免疫组织化学染色和进行定量图像分析,比较各组中BMP-7达阳性单位的差异。结果慢性HBV感染者肝组织中BMP-7表达在随着炎症和纤维化严重程度的增加而增多;肝脏重度炎症时,肝组织中BMP-7表达明显增加,与纤维化程度无关;同样肝脏重度纤维化时,肝组织中BMP-7表达明显增加,与炎症程度无关。结论BMP-7在慢性肝炎肝纤维化发生过程中可能发挥抗炎和抗纤维化作用。     

Histological grading and staging in chronic hepatitis: its practical correlation

Although the histological features of various causes of chronic liver disease have been well described, usually the inflammatory activity of the disease is important after the cause has been established. Some patients have co-infection or concomitant liver disease and on occasion it is difficult to decide the treatment. In order to clarify the histological differences, we investigated the inflammatory activity among autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), chronic hepatitis C (CHC) and chronic hepatitis B (CHB) in a standardized way using the modified histological activity index (HAI). According to the modified HAI, inflammatory activity is divided into four categories; categories A/D explains portal/periportal inflammation and categories B/C explains lobular activity. The inflammatory score of AIH tended to be greater in all categories from the early stage of fibrosis, whereas scores of PBC were lower, except for portal inflammation. Chronic hepatitis C patients had portal or periportal inflammation, and their inflammatory scores were linked to the development of fibrosis. Chronic hepatitis B patients tended to have severe lobular injury, but did not have a relationship between the inflammatory score and their stage. To know the distribution of inflammation using the modified HAI scoring system may be helpful and convenient in evaluating patients with chronic inflammatory liver disease.     

Expression of Bax, Bcl-xL and Bcl-2 proteins in relation to grade of inflammation and stage of fibrosis in chronic hepatitis C

AIMS: To determine the expression of regulators of apoptosis in chronic hepatitis C. METHODS AND RESULTS: Expression of Bax, Bcl-xL and Bcl-2 proteins was assessed immunohistochemically in liver biopsy specimens obtained from 89 adults with chronic hepatitis C. Expression of Bax in hepatocytes correlated inversely with grade of inflammation (P < 0.001) and stage of fibrosis (P = 0.011), classified according to the Scheuer score; expression of Bcl-xL in hepatocytes did not correlate with grade of inflammation (P = 0.106) or stage of fibrosis (P = 0.078); maximum Bcl-xL expression was observed in grade 3 inflammation and stage 4 fibrosis. Expression of Bcl-2 protein in hepatocytes was present in only two cases (both with advanced disease); the expression of Bcl-2 protein in interlobular bile duct epithelial cells correlated with the grade of inflammation (P = 0.018), but not with stage of fibrosis (P = 0.154). The expression of Bcl-2 protein in lymphoid cells infiltrating portal zones and lobules did not correlate with grade of inflammation (P = 0.113) or stage of fibrosis (P = 0.815). CONCLUSION: Major differences in expression of studied proteins were observed in relation to grade of inflammation and stage of fibrosis in chronic hepatitis C.     

Integrin up-regulation in chronic liver disease: relationship with inflammation and fibrosis in chronic hepatitis C.

In 94 patients with chronic hepatitis C, the pattern of integrin expression was correlated with firstly, the histological activity index, necro-inflammatory grade, and stage of fibrosis; secondly, the expression of inflammatory markers including ICAM-1; and thirdly, the extent and intensity of laminin deposition in the perisinusoidal matrix. Immunohistochemical results were evaluated according to a semi-quantitative scoring system or by image analysis. Increased beta1 expression was observed in 88.2% of cases. The expression of alpha1 and alpha5 was increased in 55% and 58.5% of cases, respectively. alpha6 chain was detected in 78.7% of cases. There were no statistically significant differences in integrin expression level according to Knodell's score, inflammatory grade, or stage of fibrosis. ICAM-1 expression was higher in patients with high scores for beta1 expression, but the differences were not statistically significant. There were significantly more patients with high scores for beta1 expression among those with continuous perisinusoidal deposition of laminin. Moreover, a close statistical correlation was observed between alpha6 induction and perisinusoidal laminin deposition (p<0.001). The results suggest that integrin up-regulation in chronic hepatitis C is more closely related to the fibrotic process than to the inflammatory lesions. This reinforces the idea that integrin induction in chronic liver disease is part of a coordinated process involved in the progression of liver fibrosis.     

基于随机森林算法的阿尔茨海默症医学影像分类

为实现阿尔茨海默症(AD)的医学影像分类,辅助医生对患者的病情进行准确判断,本研究对采集的34名AD患者、35名轻度认知障碍患者和35名正常对照组成员的功能磁共振影像进行特征提取和分类,具体思路包括:首先利用皮尔逊相关系数计算脑区之间的功能连接,然后采用随机森林算法对被试不同脑区之间的功能连接进行重要性度量及特征选择,最后使用支持向量机分类器进行分类,利用十倍交叉验证估算分类准确率。实验结果显示,随机森林算法可以对功能连接特征进行有效分析,同时得到AD发病过程的异常脑区,基于随机森林和SVM建立的分类模型对AD、轻度认知障碍的识别具有较好的效果,分类准确率可达90.68%,相关结论可以为AD的早期临床诊断提供客观参照。 【关键词】阿尔茨海默症;功能磁共振成像;随机森林;特征选择     

Operational scores in the diagnosis of chronic hepatitis. A semi-quantitative assessment

Starting from the quantification of the specific lesions for chronic hepatitis B and C, our study focused on (i) the correspondence between the necroinflammatory activity and the fibrosis stage ascertained through the Ishak scoring system, (ii) the classification overlaps and differences of Ishak vs. METAVIR score. The study group consisted of 202 cases with chronic hepatitis B and 751 cases with chronic hepatitis C, diagnosed based on liver biopsies. The fragments of hepatic tissue were routinely processed and stained with Hematoxylin-Eosin, trichrome Szekely, Gordon-Sweet silver impregnation, and Periodic Acid-Schiff. A semiquantitative evaluation was performed using the Ishak (for hepatitis B and C) and the METAVIR (for hepatitis C) scoring systems. Our results revealed that the comparison between hepatitis B and C, based on the necroinflammatory activity and fibrosis, is able to offer through the numeric values of the Ishak scoring system accurate proofs, which support the aggressivity of hepatitis C, because it develops fibrosis more quickly, even on the background of mild necroinflammatory activity. Also, our data showed that the necroinflammatory activity and the fibrosis are not processes which progress in a consistent pattern. The application of the METAVIR scoring system for the cases with chronic hepatitis C confirmed that there is not a direct correlation between necroinflammation and fibrosis. The Ishak scoring system provides through the wide range of numeric values attributed for the evaluation of necroinflammatory activity and fibrosis far more precise criteria for the appraisal of the degree of damage to the hepatic parenchyma at the time of the diagnosis. Supplementary, the METAVIR scoring system allows for the hepatitis C an assessment of the entire histologic activity, including the interface hepatitis and the associated lobular necrosis components. The scoring systems have unavoidably strengths and weaknesses, but the choice of a specific one must reflect the consensus between the pathologists and the clinicians, relying on their experience.     

Liver histology in patients on hemodialysis with chronic hepatitis C viral infection

Hepatitis C virus (HCV) is a major cause of chronic liver disease in patients on hemodialysis. As no useful noninvasive predictors of disease activity and fibrosis have been found, liver biopsy is essential in these patients to accurately assess the severity of disease and thus the prognosis and plan management. The present study was undertaken to assess the degree of severity of necroinflammatory changes and fibrosis in liver biopsies of patients on hemodialysis with chronic HCV infection. Liver biopsies obtained from 45 patients on hemodialysis with serological evidence of chronic hepatitis C were studied. The grading of necroinflammatory activity and staging of fibrosis were histologically assessed. The majority of patients (30, i.e. 66.7%) had mild disease with mild inflammatory activity and stage 0, 1 or 2 fibrosis. There was no significant correlation between the degree of fibrosis and the age of the patients (rs = 0.015), the duration of hemodialysis (rs = 0.047) or the presence of steatosis (rs = 0.064). There was a positive correlation between the presence of bile ductular proliferation and the severity of fibrosis (rs = 0.612). It was concluded that chronic HCV infection in hemodialysis patients is relatively mild early in its course. However, serial follow-up liver biopsies are mandatory to plan appropriate intervention strategies.     

Various scoring systems evaluating histologic features of chronic hepatitis C treated with interferon

Various scoring systems for chronic hepatitis have been proposed; however, there is no standard scoring system for studies of interferon (IFN) therapy in patients with chronic hepatitis C. The aims of this study were to determine the most useful system reflecting histologic changes in biopsy specimens from complete responders and predicting the efficacy of IFN therapy. Patients with chronic hepatitis C were administered IFN-alpha for 6 months. Forty-six patients were included in this study and categorized as complete responders (n = 15), partial responders (n = 24), and nonresponders (n = 7) according to viral and biochemical responses to the therapy. Biopsy specimens obtained from each patient before and after treatment were evaluated under 3 different systems: Histological Activity Index (HAI), modified HAI, and Scheuer classification. Complete responders showed considerable improvement in both grade and stage on the modified HAI and Scheuer classifications. On the HAI, a considerable improvement was observed in grade but not in stage. No significant change was observed in partial responders or nonresponders on any system. Prediction of complete response was not possible under any system, but the pretreatment score reflecting piecemeal necrosis on any 1 of the 3 classifications and the fibrosis score on Scheuer classification were predictors of nonresponse. The modified HAI system and Scheuer classification were amply useful in evaluating histologic changes in complete responders. Scores higher than 4 of the categories reflecting piecemeal necrosis on any system and fibrosis scores of 3 or 4 on Scheuer classification predicted nonresponse to IFN therapy.     

An attempt to improve classification of HCV-correlated chronic hepatitis

To verify the clinical efficacy of the Desmet classification of chronic hepatitis C we reviewed 801 liver biopsies from patients with HCV-chronic hepatitis (CH). The diagnosis of chronic hepatitis was assessed according to the Desmet classification based on the Knodell Histological Activity Index (HAI) (minimal CH=score 1-3; mild CH= 4-8; moderate CH= 9-12; severe CH= 13-18). Liver fibrosis was assessed according to the Scheuer scoring system. One hundred forty-eight patients had cirrhosis and 653 CH. Of these 653, according to the Desmet classification 145 patients showed minimal, 424 mild, 73 moderate and 11 severe chronic hepatitis. Since the classification underestimated the moderate and severe forms of HCV-related chronic hepatitis, we evaluated the possibility of improving the Desmet classification of chronic hepatitis C using our classification: minimal CH= score 1-3; mild CH= 4-6; moderate CH= 7-8; severe CH= 9-18. According to our classification 145 showed minimal CH, 363 mild CH, 61 moderate CH and 84 severe CH. All the 61 patients who crossed over from mild CH under the Desmet to moderate CH under our classification showed a periportal inflammation of grade 3, and all the 73 patients but 8 who crossed over from moderate to severe showed a grade of periportal inflammation higher than 3. The Desmet classification of HCV-related chronic hepatitis underestimated the severe forms of HCV-CH, while our classification seems to be suitable also for chronic hepatitis C.