肝硬度下降不能表明慢性乙型肝炎患者的纤维化消退：一项

StephenW

  
J Gastroenterol Hepatol. 2018 Oct 5. doi: 10.1111/jgh.14498. [Epub ahead of print]
Declining in liver stiffness can not indicate fibrosis regression in patients with chronic hepatitis B: A 78-week prospective study.
Dong XQ1, Wu Z1, Li J1,2, Wang GQ1,3,2, Zhao H1,2; China HepB-Related Fibrosis Assessment Research Group.
Author information

1
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
2
    Peking University International Hospital, Beijing, China.
3
    The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China.

Abstract
BACKGROUND:

Little reliable data is available about the liver stiffness measurement (LSM) for fibrosis monitoring in chronic hepatitis B (CHB) patients on antiviral therapy. We aimed to assess the accuracy of LSM in fibrosis monitoring during 78-week antiviral therapy in CHB patients.
METHODS:

556 treatment-naïve CHB patients with qualified LSM and liver biopsy at baseline were analyzed. Patients receiving entecavir-based therapy were prospectively followed to 78 weeks for second LSM and liver biopsy. Serologic detection, LSM and Liver biopsy were performed on the same day. Necro-inflammatory activity was also evaluated.
RESULTS:

Areas under receiver operating characteristics curves (AUROCs) of LSM at baseline and week 78 for significant fibrosis (≥F3), advanced fibrosis (≥F4) and liver cirrhosis (≥F5) was 0.84, 0.87, 0.83, and 0.76, 0.85, 0.88, respectively. Patients with the same fibrosis stage but higher HAI score tend to have higher LSM at baseline. Liver stiffness decreased rapidly (3.8 [1.6-8.6] kPa) in parallel with baseline HAI scores from 11.3 (7.8-16.7) kPa at baseline to 6.4 (5.1-8.8) kPa at week 78. Greater decline of LSM in patients with only inflammation improvement was observed as compared with those without inflammation improvement (5.2 [2.5-9.7] vs 1.8 [0.2-8.1] kPa, P=0.013). Baseline Ishak fibrosis score was the only predictor of 78-week fibrosis improvement (odds ratio, 1.859; P=0.000).
CONCLUSIONS:

In CHB patients receiving 78-week antiviral treatment, LSM could diagnosis different liver fibrosis stages, decrease in absolute LSM value could reflect the remission of liver inflammation, and baseline Ishak fibrosis score was the only predictor for 78-week fibrosis reversion.

This article is protected by copyright. All rights reserved.
KEYWORDS:

antiviral therapy; fibrosis regression; hepatitis B; inflammation improvement; liver stiffness measurement

PMID:
    30290019
DOI:
    10.1111/jgh.14498

StephenW

J Gastroenterol Hepatol。 2018年10月5日doi：10.1111 / jgh.14498。 [提前打印]
肝硬度下降不能表明慢性乙型肝炎患者的纤维化消退：一项为期78周的前瞻性研究。
董XQ1，吴Z1，李J1,2，王GQ1,3,2，赵H1,2;中国HepB相关纤维化评估研究组。
作者信息

1
    北京市西城区西什库街8号北京大学第一医院肝病中心传染病科，100034
2
    北京大学国际医院，中国北京。
3
    浙江大学传染病诊疗协同创新中心，浙江杭州。

抽象
背景：

关于抗病毒治疗慢性乙型肝炎（CHB）患者纤维化监测的肝硬度测量（LSM）的可靠性数据很少。我们的目的是评估LSM在CHB患者78周抗病毒治疗期间的纤维化监测中的准确性。
方法：

分析了556名未接受过治疗的CHB患者，这些患者在基线时接受了合格的LSM和肝脏活检。接受恩替卡韦治疗的患者前瞻性随访至78周进行第二次LSM和肝脏活检。血清学检测，LSM和肝脏活检在同一天进行。还评估了坏死性炎症活性。
结果：

LSM接受者操作特征曲线（AUROCs）在基线时和78周时显着纤维化（≥F3），晚期纤维化（≥F4）和肝硬化（≥F5）的面积分别为0.84,0.87,0.83和0.76,0.85,0.88 ， 分别。具有相同纤维化阶段但HAI评分较高的患者在基线时倾向于具有较高的LSM。肝脏硬度迅速下降（3.8 [1.6-8.6] kPa），与基线HAI评分平行，从基线时的11.3（7.8-16.7）kPa到第78周时的6.4（5.1-8.8）kPa。仅有炎症的患者LSM下降更多与没有炎症改善的患者相比，观察到改善（5.2 [2.5-9.7]对1.8 [0.2-8.1] kPa，P = 0.013）。基线Ishak纤维化评分是78周纤维化改善的唯一预测因子​​（优势比，1.859; P = 0.000）。
结论：

在接受78周抗病毒治疗的CHB患者中，LSM可以诊断出不同的肝纤维化阶段，绝对LSM值的降低可以反映肝脏炎症的缓解，基线Ishak纤维化评分是78周纤维化逆转的唯一预测因子​​。

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关键词：

抗病毒治疗;纤维化消退;乙型肝炎;炎症改善;肝硬度测量

结论：
    30290019
DOI：
    10.1111 / jgh.14498