{"id":2343,"date":"2015-06-23T12:47:28","date_gmt":"2015-06-23T12:47:28","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/hepsscld\/"},"modified":"2026-03-19T21:02:04","modified_gmt":"2026-03-19T21:02:04","slug":"hepsscld","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/es\/hepsscld\/","title":{"rendered":"Sistemas de Puntuaci\u00f3n Histol\u00f3gica para Enfermedad Hep\u00e1tica Cr\u00f3nica"},"content":{"rendered":"<div class=\"7ca9444b8380138fe077da07353677a4\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>La clasificaci\u00f3n y la estadificaci\u00f3n se refiere a una evaluaci\u00f3n semicuantitativa de la actividad necroinflamatoria (grado) y el grado de fibrosis (etapa) en relaci\u00f3n con hepatitis cr\u00f3nica.<br \/>\n<!--more--><br \/>\n<b>Modificaci\u00f3n Ishak para el \u00edndice de la actividad hep\u00e1tica (IAH) para la puntuaci\u00f3n de la actividad necroinflamatoria en la hepatitis cr\u00f3nica<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(A) Hepatitis de la\u00a0interfaz\u00a0periportal o periseptal (necrosis en sacabocados)<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ausente<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Leve (pocas \u00e1reas\u00a0portales,\u00a0focal)<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Leve\/moderada (la mayor\u00eda de las \u00e1reas portales,\u00a0focal)<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Moderado (alrededor continua &lt;50% de los tractos o septos)<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Severo\u00a0(alrededor continua &gt;50% de los tractos o septos)<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(B) N<\/b><b>ecrosis c<\/b><b>onfluentes\u00a0<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ausente<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis confluente focal<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis de zona 3\u00a0en algunas \u00e1reas<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis de zona 3 en la mayor\u00eda de las \u00e1reas<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis de zona 3\u00a0+ puente ocasional portal-central (P-C)<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis de zona 3\u00a0+ m\u00faltiples puentes P-C<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">5<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis panacinar o multiacinar<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">6<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(C)\u00a0Necrosis l\u00edtica\u00a0focal (irregular), apoptosis e inflamaci\u00f3n focal<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ausente<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Un foco o menos por\u00a0objetivo\u00a010x<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Dos a cuatro\u00a0focos\u00a0por objetivo 10x<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Cinco a diez\u00a0focos\u00a0por\u00a0objetivo\u00a010x<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">M\u00e1s de diez focos por\u00a0objetivo\u00a010x<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>(D) Inflamaci\u00f3n portal\u00a0<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ausente<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Leve, algunas o todas las \u00e1reas portales<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Moderado, algunas o todas las \u00e1reas portales<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Moderado\/marcado, todas las \u00e1reas portales<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Marcado, todas las \u00e1reas portales<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Clasificaci\u00f3n\u00a0Scheuer para la graduaci\u00f3n y estadificaci\u00f3n de la hepatitis cr\u00f3nica<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 432px;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Grado\u00a0Portal\/actividad periportal<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ninguno<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Inflamaci\u00f3n portal<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis en sacabocados leve<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis en sacabocados moderada<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis en sacabocados severa<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Actividad lobulillar<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ninguno<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Inflamaci\u00f3n pero no necrosis<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Necrosis focal o cuerpos acid\u00f3filos<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Da\u00f1o celular focal severo<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Da\u00f1o que incluye necrosis en puente<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"height: 24px;\" colspan=\"2\" valign=\"TOP\" width=\"525\"><b>Estadio de la fibrosis<\/b><\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Ninguno<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Tractos porta fibr\u00f3ticos agrandados<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Septos\u00a0porta-portales o periportales, pero arquitectura intacta<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Fibrosis con distorsi\u00f3n de la arquitectura, pero sin cirrosis obvia<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\" valign=\"TOP\">\n<td style=\"height: 24px;\" width=\"457\">Cirrosis probable o definitiva<\/td>\n<td style=\"height: 24px; text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><b>Clasificaci\u00f3n\u00a0Metavir para la estadificaci\u00f3n de la enfermedad hep\u00e1tica por hepatitis C<\/b><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr valign=\"TOP\">\n<td width=\"457\">Sin cicatrices<\/td>\n<td style=\"text-align: center;\" width=\"68\">0<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Cicatrices m\u00ednimas<\/td>\n<td style=\"text-align: center;\" width=\"68\">1<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">La cicatrizaci\u00f3n se ha producido y se extiende fuera de las zonas en el h\u00edgado que contiene vasos sangu\u00edneos<\/td>\n<td style=\"text-align: center;\" width=\"68\">2<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Fibrosis en puente que se est\u00e1 extendiendo y conectando a otras \u00e1reas que contienen fibrosis<\/td>\n<td style=\"text-align: center;\" width=\"68\">3<\/td>\n<\/tr>\n<tr valign=\"TOP\">\n<td width=\"457\">Cirrosis o cicatrizaci\u00f3n avanzada del h\u00edgado<\/td>\n<td style=\"text-align: center;\" width=\"68\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><b>Bibliograf\u00eda:<\/b><\/p>\n<ol>\n<li>Christensen C, Bruden D, Livingston S, Deubner H, Homan C, Smith K, Oh E, Gretch D, Williams J, McMahon B. Diagnostic accuracy of a fibrosis serum panel (FIBROSpect II) compared with Knodell and Ishak liver biopsy scores in chronic hepatitis C patients.\u00a0J Viral Hepat. 2006 Oct;13(10):652-8.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16970596\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Theise ND. Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach. Mod Pathol. 2007 Feb;20 Suppl 1:S3-14.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17486049\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Hudacko R, Theise N. Liver biopsies in chronic viral hepatitis: beyond grading and staging.\u00a0Arch Pathol Lab Med. 2011 Oct;135(10):1320-8.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21970487\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Ishak K1, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995 Jun;22(6):696-9.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7560864\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Borcak D, Yesilbag Z, Ozdemir YE, Demir AS, Dogdas ES, Sezen AI, Unlu EC, Senoglu S, Karaosmanoglu HK, Yasar KK. Assessing Liver Fibrosis in Chronic Hepatitis B: Liver Biopsy or Non-Invasive Fibrosis Markers? J Clin Med. 2025 Nov 18;14(22):8164. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41303199\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Creado Jun 23, 2015.<br \/>\nActualizado Mar 19, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>La clasificaci\u00f3n y la estadificaci\u00f3n se refiere a una evaluaci\u00f3n semicuantitativa de la actividad necroinflamatoria (grado) y el grado de fibrosis (etapa) en relaci\u00f3n con hepatitis cr\u00f3nica.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[146,797,145,51,50,647,796,795,524,445,794,494,798],"class_list":["post-2343","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-chronic","tag-cirrosis","tag-cronica","tag-disease","tag-enfermedad","tag-hepatica","tag-histologic","tag-histologico","tag-liver","tag-puntuacion","tag-scoring","tag-sistema","tag-systems"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2343","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/comments?post=2343"}],"version-history":[{"count":5,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2343\/revisions"}],"predecessor-version":[{"id":10720,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/2343\/revisions\/10720"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/media?parent=2343"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/categories?post=2343"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/tags?post=2343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}