标题: DDW2012:Factors That Affect the Improvement of Liver Stiffness in Patients With [打印本页] 作者: StephenW 时间: 2012-5-22 01:50 标题: DDW2012:Factors That Affect the Improvement of Liver Stiffness in Patients With
本帖最后由 StephenW 于 2012-5-22 01:52 编辑
Factors That Affect the Improvement of Liver Stiffness in Patients With Chronic Hepatitis B Sa1045 |
Oh Sang Kwon, Sunyoung Na, Young Kul Jung, Yun Soo Kim, Joo Hyun Kim
Affiliation
Internal Medicine, Gachon University Gil Medical Center, Inchon, Republic of Korea
Abstract:
Backgrounds and Aims: Oral nucleot(s)ide analogues (ONA) improve liver fibrosis in patients with chronic hepatitis B (CHB). Although liver biopsy is a standard tool for evaluation of this improvement, it is an invasive method. In addition, it is difficult to repeat liver biopsy. Transient elastography(TE), a novel noninvasive and repeatable method, is a tool for assessing liver fibrosis quantitatively by measuring liver stiffness (LS) which is well correlated with the histologic stage of fibrosis. This study investigated the factors that affect the improvement of LS in patients with CHB for about 2 years interval.
Patients and Methods: Between April 2007 and August 2011, 156 patients with CHB who underwent TE for mean 25 months interval, were retrospectively enrolled. Forty four patients were excluded due to have hepatocellular carcinoma, hepatitis C coinfection, alanine aminotransferase (ALT) >80 U/L at the time of the first TE exam, and start ONA after the first TE exam. Final 112 patients were investigated for the change of LS. Because there is some difference of interval between the two TEs, the annual change of LS was estimated [(the first LS-the second LS)Í12/interval (months)]. All the patients were grouped according to the estimated annual change of the LS >0 kPa (improved) or ≤0 kPa (aggravated).
Results: Seventy nine patients have been taking ONA before the first TE. The other 33 patients did not take ONA, because they had not indication of antiviral therapy such as low HBV DNA or low ALT levels. Seventy one patients had improvement of LS [improved group, 2.83(0.04 to 23.8) kPa], and 41 patients had aggravation of LS [aggravated group, -2.47(-29 to 0) kPa]. There were no differences in age, gender, liver functions, HBV DNA level, and proportion of liver cirrhosis at the first TE between the two groups. In addition, the proportion of low viral load (HBV DNA <2000 copies/mL) throughout the study period was not different between the two groups. However, the mean LS at the first TE was higher in improved than in aggravated group (13.4±13.2 vs. 7.6±4.7 kPa, p=0.001). The proportion of patients taking ONA was higher in improved than in aggravated group (77.5% vs. 58.5%, p=0.034). The proportion of patients having normal ALT level (<40 U/L) throughout the study period was higher in improved than in aggravated group (54.9% vs. 26.8%, p=0.004). In multivariate analysis, higher LS at the first TE (OR: 1.2, 95% CI: 1.02-1.21, p=0.011), ONA therapy (OR: 2.8, 95% CI: 1.1-7.1, p=0.031), and normal ALT throughout the study period (OR: 3.4, 95% CI: 1.4-8.2, p=0.007) were the independent factors that affect the improvement of LS.
Conclusions: Antiviral therapy or maintained normal ALT level improve LS in patients with CHB. However, further study is needed to investigate whether these results match the liver histologic study.
Disclosure(s):
The following people have nothing to disclose: Oh Sang Kwon, Sunyoung Na, Young Kul Jung, Yun Soo Kim, Joo Hyun Kim 作者: StephenW 时间: 2012-5-22 01:54