长期恩替卡韦治疗期间慢性乙型肝炎患者瞬时弹性成像对肝

StephenW

Clin Exp Med. 2018 Apr 25. doi: 10.1007/s10238-018-0501-x. [Epub ahead of print]
Longitudinal monitoring of liver fibrosis status by transient elastography in chronic hepatitis B patients during long-term entecavir treatment.
Wu SD1,2, Liu LL1,2, Cheng JL3, Liu Y1, Cheng LS1, Wang SQ1, Ma W1, Chen LP3, Tseng YJ1, Wang JY1,2, Shen XZ1,2, Jiang W4,5.
Author information

1
    Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
2
    Shanghai Institute of Liver Diseases, Shanghai, 200032, China.
3
    Department of Gastroenterology and Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
4
    Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. [email protected].
5
    Shanghai Institute of Liver Diseases, Shanghai, 200032, China. [email protected].

Abstract

The impedance between improvement in rats liver stiffness and fibrosis regression has not been normalized during long-term antiviral therapy in chronic hepatitis B (CHB) patients. In this study, liver stiffness was serially performed by FibroScan® every 26 weeks in a prospective cohort. Of CHB patients receiving entecavir. Results were compared with liver biopsies at baseline and week 78. A total of 120 treatment-naïve CHB patients were analyzed, in which 54 (45%) patients had fibrosis regression at 78 weeks of antiviral therapy. Liver stiffness. The degree presented was a rapid-to-slow decline pattern and declined more significantly in patients with fibrosis regression than those without improvement in fibrosis at week 78 (- 46.4 vs. - 28.6%, P < 0.001). Multivariate analysis revealed that that percentage declined of 52-week and 78-week liver stiffness from baseline was independent predictive factors for fibrosis regression (OR = 46.6, P < 0.001; OR = 17.8 , P = 0.002, respectively). Furthermore, percentage decline of 78-week liver stiffness was moderately predictive of fibrosis regression (AUROC = 0.694, P < 0.001), while the optimal cutoff values ​​were varied between between non-cirrhosis and cirrhosis patients (38 (vs. 45%). Fibrosis regression could be predicted with a high positive predictive value (96%) in non-cirrhosis patients and could be excluded with a high negative predictive value (94%) in cirrhosis patients. In conclusion, serial liveright Measurement could be applied for serious monitoring of fibrosis status in CHB patients. Continuous decline of liver stiffness after effective antiviral treatment could partially reflect fibrosis regression at an optimal cutoff value.
KEYWORDS:

Antiviral therapy; Chronic hepatitis B; Fibrosis regression; Liver stiffness

PMID:
    29696462
DOI:
    10.1007/s10238-018-0501-x

StephenW

Clin Exp Med。 2018年4月25日。doi：10.1007 / s10238-018-0501-x。 [电子版提前打印]
长期恩替卡韦治疗期间慢性乙型肝炎患者瞬时弹性成像对肝纤维化状态的纵向监测。
吴SD1,2，刘LL1,2，程JL3，刘Y1，程LS1，王SQ1，马W1，陈LP3，曾YJ1，王JY1,2，沉XZ1,2，江W4,5。
作者信息

1
复旦大学附属中山医院消化内科，上海，200032
2
上海市肝病研究所，上海，200032
3
复旦大学上海市公共卫生临床中心消化内科，上海201508
4
复旦大学附属中山医院消化内科，上海，200032 [email protected]。
五
上海市肝病研究所，上海，200032 [email protected]。

抽象

在慢性乙型肝炎（CHB）患者的长期抗病毒治疗期间，大鼠肝硬化改善与纤维化消退之间的阻抗尚未正常化。在本研究中，FibroScan®每26周在一个前瞻性队列中进行肝硬化。接受恩替卡韦治疗的CHB患者。结果与基线和第78周的肝活检进行比较。共分析120例未治疗的CHB患者，其中54例（45％）患者在78周抗病毒治疗后出现纤维化消退。肝硬化。呈现的程度是快速缓慢下降的模式，并且在纤维化消退的患者中比在78周时没有纤维化改善的患者的下降更显着（-46.4比-28.6％，P <0.001）。多变量分析显示，52周和78周肝脏硬度从基线下降的百分比是纤维化回归的独立预测因子（OR分别为46.6，P <0.001; OR = 17.8，P = 0.002）。此外，78周肝硬化百分比下降对纤维化消退的适度预测（AUROC = 0.694，P <0.001），而非肝硬化和肝硬化患者之间的最佳截断值有所不同（分别为38（vs. 45％ ），非肝硬化患者纤维化消退可预测高阳性预测值（96％），并可排除肝硬化患者高阴性预测值（94％）。严重监测CHB患者的纤维化状态有效的抗病毒治疗后肝硬度的持续下降可能部分反映了纤维化回归的最佳临界值。
关键词：

抗病毒治疗;慢性乙型肝炎;纤维化消退;肝硬化

结论：
29696462
DOI：
10.1007 / s10238-018-0501-X