1065
Clinical Factors Associated with Liver Stiffness
Improvement after 78 Week Antiviral Therapy in
Chronic Hepatitis B Patients
Xiao-Qin Dong, Zhao Wu, Liang Miao, Wan-Na Yang, Hong
Zhao and Guiqiang Wang, Infectious Diseases, Peking
University First Hospital
Background: Liver stiffness measurement (LSM), which
performed by transient elastography (TE, FibroScan®), has
gained popularity in non-invasive liver fibrosis assessment
in patients with chronic liver diseases. As LSM has superb
patient acceptance it has been widely used in monitoring liver
fibrosis progression and regression in the individual case, but
the accuracy of LSM in fibrosis monitoring during hepatitis B
virus (HBV) infection has not been well established. We aimed
to analyse the dynamics of LSM and compare the accuracy
of LSM in monitoring fibrosis changes during antiviral therapy
in chronic hepatitis B (CHB) patients. Methods: A total of 556
Chinese treatment-naïve CHB patients were enrolled in this
study, 183 of which had reliable paired LSM and liver biopsies
at baseline and week 78, and 250 of which had intact LSM
and liver biopsy at week 78. Serologic detection, LSM and
Liver biopsy were done within one month. Necroinflammation
and fibrosis were assessed with the Ishak scoring system.
The detailed clinical trial protocol has been registered
(NCT01962155 and ChiCTR-DDT-13003724). Results: In
treatment-naïve CHB patients, area under receiver operating
characteristics curves (AUROCs) of LSM for significant
fibrosis (F0-2 vs F3–6), advanced fibrosis (F0–3 vs F4–6)
and liver cirrhosis (F0–4 vs F5-6) was 0.84 (95% CI: 0.80-
0.87), 0.87 (95% CI: 0.84-0.89) and 0.83 (95% CI: 0.76-0.91)
respectively. Patients with the same fibrosis stage but higher
hepatitis B core antibody (anti-HBc) levels tend to have higher
LSM, and the diagnostic performance for significant fibrosis
was best when anti-HBc < 3.7 log10 IU/ml. Liver stiffness
decreased rapidly (−3.8 [1.6-8.6] kPa/78 weeks) from 11.3
(7.8-16.7) kPa at baseline to 6.4 (5.1-8.8) kPa at week 78.
More importantly, the decline of liver stiffness was in parallel
with baseline liver biochemistry levels, anti-HBc levels, alpha
fetoprotein (AFP) levels and the modified Knodell histology
activity index (HAI) , but not with baseline liver fibrosis
stages (Figure). Interestingly, After 78 week antiviral therapy,
AUROCs of LSM for significant fibrosis, advanced fibrosis and
liver cirrhosis were comparable with that in treatment-naïve
CHB patients. Conclusion: In CHB patients, LSM is useful
in monitoring liver fibrosis progression and regression before
and after antiviral therapy. The dynamic changes of LSM were
associated with the course of liver inflammation improvement
during 78 week antiviral thearpy. 作者: StephenW 时间: 2018-10-26 15:19