AASLD 2013接受恩替治疗肝脏硬度值评估3年随访研究

StephenW

TITLE: Dynamics of liver stiffness values assessed using transient elastography in patients with chronic hepatitis B receiving entecavir:

3-year follow-up study
AUTHORS (FIRST NAME, LAST NAME): Mi Na Kim1, 2, Seung Up Kim1, 2, Beom Kyung Kim1, 2, Jun Yong Park1, 2, Do Young Kim1, 2, Sang Hoon Ahn1, 2, Kwang-Hyub Han1, 2
Institutional Author(s):
INSTITUTIONS (ALL): 1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of.
2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea, Republic of.
ABSTRACT BODY: Background/Aims: Liver stiffness (LS) values using transient elastography provides accurate assessment of liver fibrosis in patients with chronic liver disease. The influence of antiviral treatment using entecavir (ETV) on LS values was assessed in patients with chronic hepatitis B (CHB).
Methods: One hundred and twenty-one NUC-naïve patients with CHB who completed 3-year ETV treatment at the end of follow-up (April 2013) were evaluated. LS was measured at the start and completion of the 3-year ETV treatment. The aim of this study was to evaluate the change in LS value under ETV therapy, and the presence of a decrease in LS value ≥1 kPa from the baseline.
Results: The mean baseline LS value of the patients was 18.0 kPa. During the 3-year ETV treatment, the mean LS values decreased significantly from 18.0 to 9.3 kPa (P<0.001). In univariate analyses, the absence of diabetes mellitus, higher HBV DNA level, normalization of alanine aminotransferase (ALT) during the study period, and higher baseline LS values were associated with a LS decrease in LS values ≥1 kPa (all P<0.05). Together with ALT normalization, multivariate analysis identified higher baseline LS values as an independent predictor of a decrease of LS values ≥1 kPa (P<0.001; hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.104–1.382). Using the optimal cutoff baseline LS value of 10 kPa (area under receiver operating characteristic curve=0.835; 95% CI, 0.732-0.937, P<0.001; sensitivity 76.5%; specificity, 73.9%), patients with baseline LS values 10≥ kPa had a greater chance of experiencing a decrease in LS values ≥1 kPa than those with baseline LS values <10 kPa (P<0.001; HR, 8.914; 95% CI, 3.231-24.597).
Conclusions: A significant decrease in LS values after 3-year ETV treatment was observed in CHB patients. The baseline LS values and ALT normalization were independent predictors of a decrease in LS value ≥1 kPa.

StephenW

背景/目的：肝脏硬度值（ LS ）使用瞬时弹性成像在慢性肝病患者肝纤维化提供了准确的评估。在慢性乙型肝炎（ CHB ）患者的抗病毒治疗，使用恩替卡韦（ ETV ） LS值的影响进行了评估。
方法：一百二十一国统会天真的后续（ 2013）年底完成3年的ETV治疗慢性乙型肝炎患者进行了评估。 LS测量的开始和完成3年的ETV治疗。这项研究的目的是评估ETV治疗下， LS值的变化和减少LS值≥1KPa从基线。
结果：患者的平均基线LS价值为18.0KPa千帕。在3年的ETV治疗，平均LS值从18.0显着下降至9.3KPa（P <0.001 ） 。在单因素分析中， HBV DNA水平较高，糖尿病，丙氨酸转氨酶（ALT ）在研究期间的正常化，和更高的基准LS值的情况下，与LS LS值下降≥ 1KPa（均P <0.05 ） 。加上ALT正常化，多变量分析确定了较高的基准LS值作为一个独立的预测减少了LS值≥ 1千帕（ P < 0.001 ;风险比[ HR ] ， 1.235 ; 95 ％信心区间[ CI]为1.104-1.382 ） 。使用最佳临界基线LS值10KPa（区下接收机操作特性曲线= 0.835 ， 95％CI 0.732-0.937 ，P <0.001 ，灵敏度为76.5 ％ ，特异性73.9％ ），患者与基线LS值10KPa≥有一个更大的机会，经历了LS值下降≥1Kpa比基线LS值小于10Kpa（ P <0.001 ; HR ， 8.914 ，95％CI 3.231-24.597 ） 。
结论： ETV治疗3年后的LS值显着减少慢性乙型肝炎患者中观察到。基线LS值和ALT正常化独立的预测减少LS值≥1Kpa。