J Ultrasound Med. 2018 Sep 23. doi: 10.1002/jum.14822. [Epub ahead of print]
Dynamic Changes of the Aspartate Aminotransferase-to-Platelet Ratio and Transient Elastography in Predicting a Histologic Response in Patients With Chronic Hepatitis B After Entecavir Treatment.
Sun J1, Li Y1, Sun X1, Yu H1, Liu Y1.
Author information
1
Department of Hepatology, Yantai Infectious Disease Hospital, Yantai, China.
Abstract
OBJECTIVES:
To evaluate the dynamic changes of the aspartate aminotransferase (AST)-to-platelet ratio and transient elastography (FibroScan; Echosens, Paris, France) in predicting a histologic response in patients with chronic hepatitis B (CHB) after entecavir treatment.
METHODS:
A total of 148 patients with CHB were enrolled. Patient information was collected. All patients received liver biopsy and FibroScan before and after 96 weeks of entecavir treatment.
RESULTS:
Baseline liver biopsy results showed that there were 7 patients without liver fibrosis (fibrosis stage F0; 4.7%), 51 patients with mild liver fibrosis (F1; 34.5%), and 90 patients with advanced liver fibrosis (>F1; 60.9%). The liver stiffness value and AST-to-platelet ratio increased significantly as the METAVIR score of the patients increased from F0 to F4 (P < .001). After antiviral therapy for 96 weeks, the average liver stiffness value measured by FibroScan and the AST-to-platelet ratio showed a significant decrease. When we use a decreased liver stiffness value to predict a histologic response, the area under the receiver operating characteristic curve was 0.70 (95% confidence interval, 0.61-0.79; P < .001), and the sensitivity and specificity were 74.3% and 68.8%, respectively. The decrease of the AST-to-platelet ratio also could predict the histologic response of patients with CHB; the area under the receiver operating characteristic curve was 0.77 (95% confidence interval, 0.69-0.86; P < .001) with sensitivity of 76.2% and specificity of 70.2%. A multivariate analysis indicated that a high hepatitis B virus DNA viral load (odds ratio, 1.44; P = .04) and high METAVIR score (odds ratio, 1.38; P = .02) were independent risk factors for the histologic response.
CONCLUSIONS:
Both the AST-to-platelet ratio and FibroScan value can effectively predict a histologic response in patients with CHB during entecavir treatment. Therefore, they can be used to monitor these patients during antiviral treatment to avoid multiple liver biopsies.
基线肝活检结果显示，7例无肝纤维化（纤维化分期F0; 4.7％），51例轻度肝纤维化（F1; 34.5％），90例晚期肝纤维化（> F1; 60.9％）。随着患者METAVIR评分从F0增加到F4，肝硬度值和AST与血小板比值显着增加（P <.001）。在抗病毒治疗96周后，通过FibroScan测量的平均肝硬度值和AST与血小板比率显示显着降低。当我们使用降低的肝硬度值来预测组织学反应时，受试者工作特征曲线下面积为0.70（95％置信区间，0.61-0.79; P <.001），敏感性和特异性分别为74.3％和68.8 ％， 分别。 AST与血小板比值的降低也可预测CHB患者的组织学反应;受试者工作特征曲线下面积为0.77（95％置信区间，0.69-0.86; P <.001），敏感性为76.2％，特异性为70.2％。多变量分析表明，高乙型肝炎病毒DNA病毒载量（优势比，1.44; P = .04）和高METAVIR评分（优势比，1.38; P = .02）是组织学反应的独立危险因素。
结论：