Fibroscan评估的慢性乙型肝炎患者晚期纤维化后长期抗病毒治

StephenW

Am J Gastroenterol 2017; 112:882–891; doi:10.1038/ajg.2017.93; published online 4 April 2017

        Improvement of Liver Fibrosis after Long-Term Antiviral Therapy Assessed by Fibroscan in Chronic Hepatitis B Patients With Advanced Fibrosis

Young Eun Chon MD, PhD1, Jun Yong Park MD, PhD2,3, Sung-Min Myoung PhD4, Kyu Sik Jung MD2,3, Beom Kyung Kim MD, PhD2,3, Seung Up Kim MD, PhD2,3, Do Young Kim MD, PhD2,3, Sang Hoon Ahn MD, PhD2,3 and Kwang-Hyub Han MD, PhD2,3

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

Correspondence: Jun Yong Park, MD, PhD, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. E-mail: [email protected]

Received 1 August 2016; Accepted 7 February 2017
Advance online publication 4 April 2017

Top of pageAbstractObjectives:

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.

StephenW

Am J Gastroenterol 2017; 112：882-891; DOI：10.1038 / ajg.2017.93;于2017年4月4日在线发布
Fibroscan评估的慢性乙型肝炎患者晚期纤维化后长期抗病毒治疗后肝纤维化改善

Young Eun Chon MD，PhD1，Jun Yong Park MD，PhD2,3，Sung-Min Myoung PhD4，Kyu Sik Jung MD2,3，Beom Kyung Kim MD，PhD2,3，Seung Up Kim MD，PhD2,3，Do Young Kim MD，PhD2,3，Sang Hoon Ahn MD，PhD2,3和Kwang-Hyub Han MD，PhD2,3

    韩国城南医院CHA大学医学中心内科
    延安大学医学院消化内科研究所内科，韩国首尔
    韩国首尔市继任医院3月延长中心
    韩国Goesan，原川大学健康科学学院医学信息与管理系

通讯作者：Jun勇公园，延边大学医学院消化内科研究所内科医学博士，韩国首尔03722，Seoreemun-gu延安西50号。电邮：[email protected]

收到2016年8月1日于2017年2月7日接受
2017年4月4日提前在线发布
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抽象
目标：

进行重复肝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概率较高（81.5％vs. 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指标。