Modified HAI grading
慢性B型肝炎、慢性C型肝炎の評価に用いられる。細かく分類されているが、各項目のScoreを合計し、その数でActivityとFibrosisを評価する。最終的には犬山分類と同じ様になる。
Activity: Minimal (A0: 0-3), Mild (A1: 4-8), Moderate (A2: 9-12), Severe (A3: 13-18)
Fibrosis: Absent (F0: 0), Mild (F1:1-2), Moderate (F2:3), Severe (F3: 4-5), Cirrhosis (F4:6)
| Necroinflammatory scores (Acitivity (A)) | Score |
| A. Periportal or periseptal interface hepatitis (piecemeal necrosis) | |
| Absent | 0 |
| Mild (focal, few portal areas) | 1 |
| Mild/moderate (focal, most portal areas) | 2 |
| Moderate (continuous around <50% of tracts of septa) | 3 |
| Severe (continuous around >50% of tracts of septa) | 4 |
| B. Confluent necrosis | |
| Absent | 0 |
| Focal confluent necrosis | 1 |
| Zone 3 necrosis in some areas | 2 |
| Zone 3 necrosis in most areas | 3 |
| Zone 3 necrosis + occasional portal-central (P-C) bridging | 4 |
| Zone 3 necrosis + multiple P-C bridging | 5 |
| Panacinar or multiacinar necrosis | 6 |
| C. Focal (spotty) lytic necrosis, apoptosis and focal inflammationa) | |
| Absent | 0 |
| One focus or less per 10× objective | 1 |
| Two to four foci per 10× objective | 2 |
| Five to ten foci per 10× objective | 3 |
| More than ten foci per 10× objective | 4 |
| D. Portal inflammation | |
| None | 0 |
| Mild, some or all portal areas | 1 |
| Moderate, some or all portal areas | 2 |
| Moderate/marked, all portal areas | 3 |
| Marked, all portal areas | 4 |
a) Does not include diffuse sinusoidal infiltration by inflammatory cells.
Additional features which should be noted but not scored:
•Bile-duct inflammation and damage
•Lymphoid follicles
•Steatosis, mild moderate or marked
•Hepatocellular dysplasia, large- or small-cell
•Adenomatous hyperplasia
•Iron or copper overload
•Intracellular inclusions (eg. PAS-positive globules, Mallory bodies)
Immunohistochemical findings
•Information on viral antigens, lymphocyte subsets or other features, when available, should be recorded and may be semi-quantitatively expressed.
| Architectural changes, fibrosis and cirrhosisb) (Fibrosis (F)) | Score |
| No fibrosis | 0 |
| Fibrous expansion of some portal areas, with or without short fibrous septa | 1 |
| Fibrous expansion of most portal areas, with or without short fibrous septa | 2 |
| Fibrous expansion of most portal areas, with occasional portal-portal (P-P) bridging | 3 |
| Fibrous expansion of portal areas, with marked bridging (portal to portal (P-P) as well as portal to central (P-C)) | 4 |
| Marked bridging (P-P and/or P-C) with occasional nodules (incomplete cirrhosis) | 5 |
| Cirrhosis, probable or definite | 6 |
b) Additional features which should be noted but not scored: Intra-acinar fibrosis, perivenular (‘chicken wire’ fibrosis) and phlebosclerosis of terminal hepatic venules.
文献：
1. Ishak K, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696-9.
2. Knodell RG, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1:431-5.
執筆日：2013/06/27
執筆者：神戸大学医学部附属病院病理診断科 酒井康裕
