Fibroscan在慢性乙型肝炎患者进行高级纤维化评估的长期抗病

StephenW

Am J Gastroenterol. 2017 Apr 4. doi: 10.1038/ajg.2017.93. [Epub ahead of print]
Improvement of Liver Fibrosis after Long-Term Antiviral Therapy Assessed by Fibroscan in Chronic Hepatitis B Patients With Advanced Fibrosis.
Chon YE1, Park JY2,3, Myoung SM4, Jung KS2,3, Kim BK2,3, Kim SU2,3, Kim DY2,3, Ahn SH2,3, Han KH2,3.
Author information

1    Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
2    Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
3    Yonsei Liver Center, Severance Hospital, Seoul, Korea.
4    Department of Medical Information and Administration, College of Health Science, Jungwon University, Goesan, Korea.

Abstract
OBJECTIVES:

Performing repeated liver biopsies to assess the improvement of liver fibrosis is impractical. The purpose of this prospective cohort study was to assess the improvement of liver fibrosis during antiviral treatment by serial liver stiffness (LS) measurement using Fibroscan in chronic hepatitis B (CHB) patients with advanced fibrosis.
METHODS:

Nucleos(t)ide analog-naive CHB patients with advanced fibrosis in histological findings (stage ≥F3), high viral load (hepatitis B virus DNA ≥2,000 IU/ml), and normal liver enzyme levels (<2 × upper normal limit) before starting antiviral treatment were included in this study. LS measurement was performed at baseline and annually for 5 years during antiviral treatment. Five-year fibrosis improvement was defined as LS value <7.2 kPa (<F3) at year 5.
RESULTS:

The mean LS value of 120 patients significantly decreased over time (14.5 kPa at baseline; 11.3 kPa at year 1; 9.6 kPa at year 2; 9.3 kPa at year 3; 8.6 kPa at year 4; and 8.3 kPa at year 5). Multivariate analysis showed that baseline LS value was the only predictor of 5-year fibrosis improvement (odds ratio, 0.907; 95% confidence interval, 0.838-0.980; P=0.014). Patients with low baseline LS values (<12.0 kPa) had a greater probability of experiencing significant fibrosis improvement than those with high baseline LS values (≥12.0 kPa) (81.5% vs. 29.0%, P<0.001).
CONCLUSIONS:

In CHB patients with advanced fibrosis receiving antiviral treatment, annual LS measurement revealed that fibrosis improvement slows but continues during treatment. Low LS value (<12.0 kPa) at baseline was a significant predictor for 5-year fibrosis improvement.Am J Gastroenterol advance online publication, 4 April 2017; doi:10.1038/ajg.2017.93.

PMID:
    28374814
DOI:
    10.1038/ajg.2017.93

StephenW

Am J Gastroenterol。 2017年4月4. doi：10.1038 / ajg.2017.93。 [提前印刷]
Fibroscan在慢性乙型肝炎患者进行高级纤维化评估的长期抗病毒治疗后肝纤维化改善。
Chon YE1，Park JY2,3，Myoung SM4，Jung KS2,3，Kim BK2,3，Kim SU2,3，Kim DY2,3，Ahn SH2,3，Han KH2,3。
作者信息

1韩国城南大学医学中心CHA大学内分泌科。
2延年大学医学院胃肠病研究所内科，韩国首尔。
韩国首尔延边医院继任医院3号。
4韩国Goesan中原大学健康科学学院医学信息与管理系。

抽象
目标：

进行重复肝脏活检以评估肝纤维化的改善是不切实际的。这项前瞻性队列研究的目的是通过使用Fibroscan在慢性乙型肝炎（CHB）晚期纤维化患者中进行连续肝硬化（LS）测量来评估抗病毒治疗期间肝纤维化的改善。
方法：

在病理学发现（阶段≥F3），高病毒载量（乙型肝炎病毒DNA≥2,000IU / ml）和正常肝酶水平（<2×正常上限）下，具有晚期纤维化的核素（T）在开始抗病毒治疗之前，包括在本研究中。在抗病毒治疗期间，基线进行LS测量，每年进行5年。五年纤维化改善定义为第5年的LS值<7.2 kPa（<F3）。
结果：

120例患者的平均LS值随着时间的推移显着降低（基线14.5 kPa，第1年为11.3 kPa;第2年为9.6 kPa;第3年为9.3 kPa;第4年为8.6 kPa;第5年为8.3 kPa）。多变量分析显示，基线LS值是5年纤维化改善的唯一预测因素（优势比为0.907; 95％置信区间，0.838-0.980; P = 0.014）。低基线LS值（<12.0 kPa）的患者与基线LS值（≥12.0kPa）相比，经历显着纤维化改善的可能性更大（81.5％对29.0％，P <0.001）。
结论：

在接受抗病毒治疗的晚期纤维化的CHB患者中，年度LS测量显示纤维化改善减缓，但在治疗期间继续。基线时低LS值（<12.0 kPa）是5年纤维化改善的重要预测因素.J Gastroenterol在线发布，2017年4月4日; doi：10.1038 / ajg.2017.93。

PMID：
    28374814
DOI：
    10.1038 / ajg.2017.93