肝纖維化的嚴重程度已知與肝癌風險正相關，國內最新研究更發現，C肝病毒患者的肝纖維化若從中度（F2）進展到重度（F3），肝癌風險便急遽上升。目前政府針對C肝全口服新藥的健保給付條件中，僅納入重度纖維化（F3）C肝患者。

肝臟反覆發炎、損傷 容易造成肝纖維化

台灣肝臟研究學會暨社團法人台灣肝病醫療策進會會長高嘉宏指出，肝臟是沉默的器官，若經過反覆發炎，細胞持續慢性損傷，歷經結疤又修復過程，肝臟內結締組織會異常增多、逐漸變硬，此過程即是所謂的肝纖維化。肝纖維化分為5期，F0為無纖維化，F1是輕度纖維化，F2是中度，F3則達到重度，F4已達肝硬化。及早治療才能避免肝硬化、肝癌憾事發生。

高雄醫學大學附設中和紀念醫院肝膽胰內科主治醫師余明隆說明，如同皮膚受傷之後會結疤，原本柔軟、光滑的肝臟若反覆發炎，細胞經過破壞，雖已修復也會產生傷疤。正常（F0）與輕度纖維化（F1）的肝臟，如同新鮮的生豬肝，光澤亮、觸感光滑；中度肝纖維化（F2）的肝臟就像是煮熟的豬肝，顏色黯淡、觸感略硬；重度纖維化（F3）的肝臟像是熟豬肝放冷後，顏色逐漸轉黑，觸感堅硬；F4等同於肝硬化初期，肝臟如同木柴一樣硬梆梆，又稱作「柴肝」。

40歲以上、中度肝纖維化 增加肝癌風險

高雄醫學大學附設中和紀念醫院團隊研究追蹤1281名C肝患者5.5年，患者平均50.6歲。分析發現，年齡（40歲以上）與中度肝纖維化（F2）都是大幅增加肝癌風險的重要危險因子。相較於輕度纖維化已治癒患者（F0－F1），中度肝纖維化（F2）未治癒患者罹患肝癌的風險機率為6.55倍；未治癒中度肝纖維化（F2）患者對照無纖維化、輕度纖維化（F0－F1）患者，罹患肝癌的風險機率為3.7倍，顯示未治癒肝纖維化從F1惡化進展到F2時，罹患肝癌的機率會提升2.7倍。

關心自身肝臟健康，除抽血篩檢，也應了解肝纖維化狀態，及早發現肝纖維化主因並進行治療，讓纖維化停滯不繼續惡化，可大幅降低肝硬化、肝癌風險。以慢性C型肝炎為例，食品藥物管理署已核准5款針對特定基因型以及1款泛基因型（GT1－6）的全口服新藥。早期根治C肝、清除病毒，停止病毒對肝臟的持續傷害，進而降低肝硬化、肝癌及肝臟外病變風險。

抽血報告4數值加上年齡 可計算出肝纖維化指數

然而許多潛在C肝病患不曾篩檢，或是不知道自己肝纖維化狀態，恐錯失治療先機。高嘉宏教授表示，目前要得知纖維化等級，可透過肝臟組織切片、非侵入性的肝纖維化掃描，與抽血後以公式計算「肝纖維化指數」。只要取得基層診所或是檢驗所、健檢機構提供抽血報告中，最標準的3個血液生化指標：血小板、與肝功能指數ALT、AST，再加上「年齡」。

將4個數值帶入公式中，便能得到肝纖維化指數。分數越高，代表纖維化越嚴重。FIB-4分數小於1.45代表正常；大於1.45屬於輕微纖維化；大於2.1是中度肝纖維化；大於3.25則屬於嚴重肝纖維化。

中度肝纖維化以上患者幾乎沒有明顯症狀

余明隆教授表示，臨床經驗發現，中度肝纖維化（F2）以上患者幾乎沒有明顯症狀，難以敏銳察覺早期發現。許多患者就醫時通常已是重度肝纖維化或肝硬化，甚至是肝癌，難以醫治。定期篩檢、及早診斷益為重要。民國55年或以後出生且滿45歲民眾，於接受成人預防保健服務 時應搭配B、C型病毒肝炎篩檢服務。

余明隆教授說，美國等先進國家對於肝炎篩檢採主動出擊為策略，只要是高風險族群都須做C肝篩檢。例如曾經皮穿刺患者、曾使用靜脈注射毒品、接受過輸血或器官移植、長期洗腎，或原本即有肝功能異常者，以大幅達成早期發現、早期治療目標。

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The severity of liver fibrosis is known to be positively correlated with the risk of liver cancer. The latest research in China has found that if the liver fibrosis of patients with C-hepatitis progresses from moderate (F2) to severe (F3), the risk of liver cancer will increase rapidly. At present, the government only includes severe fibrosis (F3) C liver patients for the health insurance payment conditions for C-hepatic oral new drugs.

Liver repeatedly inflamed, damaged, easily lead to liver fibrosis

Gao Jiahong, president of the Taiwan Liver Research Society and Association of Taiwanese Liver Diseases Medical Association, pointed out that the liver is a silent organ. If it is repeatedly inflamed, the cells continue to be chronically damaged. After crusting and repairing, the connective tissue in the liver will increase abnormally and gradually. Hard, this process is called liver fibrosis. Liver fibrosis is divided into 5 stages, F0 is no fibrosis, F1 is mild fibrosis, F2 is moderate, F3 is severe, and F4 has reached cirrhosis. Early treatment can avoid cirrhosis and liver cancer.

Yu Minglong, attending physician of the Department of Hepatobiliary and Pancreatic Medicine of the Zhonghe Memorial Hospital, Kaohsiung Medical University, said that if the skin is scarred after the skin is injured, if the original soft and smooth liver is repeatedly inflamed, the cells will be destroyed, and although it has been repaired, it will cause scars. Normal (F0) and mild fibrosis (F1) liver, like fresh pig liver, with bright luster and smooth touch; moderate liver fibrosis (F2) liver is like cooked pig liver, color is dull, touch Slightly hard; severe fibrosis (F3) liver like cooked pig liver after cooling, the color gradually turns black, hard to touch; F4 is equivalent to the early stage of cirrhosis, the liver is as hard as firewood, also known as "chai liver".

40 years of age or older, moderate liver fibrosis increases the risk of liver cancer

Kaohsiung Medical University attached a team of Zhonghe Memorial Hospital to track 1,281 patients with C liver for 5.5 years, with an average of 50.6 years. The analysis found that age (40 years and older) and moderate liver fibrosis (F2) are important risk factors for significantly increasing the risk of liver cancer. Compared with patients with mild fibrosis who have been cured (F0-F1), the risk of liver cancer in patients with moderate hepatic fibrosis (F2) is 6.55 times; patients without untreated moderate fibrosis (F2) have no fibrosis. In patients with mild fibrosis (F0-F1), the risk of developing liver cancer is 3.7 times, indicating that the unhealed liver fibrosis progresses from F1 to F2, and the risk of liver cancer increases by 2.7 times.

Concerned about your own liver health, in addition to blood screening, you should also understand the state of liver fibrosis, early detection of liver fibrosis and treatment, so that fibrosis stagnation does not continue to deteriorate, can significantly reduce the risk of liver cirrhosis, liver cancer. Taking chronic hepatitis C as an example, the Food and Drug Administration has approved five new oral new drugs for specific genotypes and one pan-genotype (GT1-6). Early eradication of C liver, clearing the virus, stopping the virus from continuing damage to the liver, thereby reducing the risk of liver cirrhosis, liver cancer and extrahepatic lesions.

Blood draw report 4 value plus age can calculate liver fibrosis index

However, many potential C-hepatic patients have not been screened, or do not know their liver fibrosis status, fear of missed treatment. Professor Gao Jiahong said that it is necessary to know the degree of fibrosis, through liver tissue sectioning, non-invasive liver fibrosis scanning, and formulating the "liver fibrosis index" after blood drawing. As long as the grassroots clinics or the inspection institutes and health inspection agencies provide blood sampling reports, the three most standard blood biochemical indicators: platelets, liver function index ALT, AST, plus "age".

The liver fibrosis index can be obtained by taking four values ??into the formula. The higher the score, the more severe the fibrosis. FIB-4 scores less than 1.45 represent normal; greater than 1.45 is mild fibrosis; greater than 2.1 is moderate liver fibrosis; greater than 3.25 is severe liver fibrosis.

Patients with moderate liver fibrosis have few obvious symptoms

Professor Yu Minglong said that clinical experience has found that patients with moderate liver fibrosis (F2) or above have almost no obvious symptoms, and it is difficult to be acutely aware of early detection. Many patients often have severe liver fibrosis or cirrhosis, or even liver cancer, and are difficult to treat. Regular screening and early diagnosis are important. People who have been born in the Republic of China for 55 years or later and who are 45 years old should be equipped with hepatitis B and C virus screening services when receiving adult preventive health services.

Professor Yu Minglong said that advanced countries such as the United States have taken the initiative to attack hepatitis screening, as long as it is a high-risk group. For example, patients who have had skin puncture, have used intravenous drugs, have received blood transfusion or organ transplantation, have long-term dialysis, or have abnormal liver function to achieve early detection and early treatment goals.