天冬氨酸氨基转移酶与血小板比值的动态变化和瞬时弹性成

StephenW

Dynamic Changes of the Aspartate Aminotransferase-to-Platelet Ratio and Transient Elastography in Predicting a Histologic Response in Patients With Chronic Hepatitis B After Entecavir Treatment; Sun J, Li Y, Sun X, Yu H, Liu Y; Journal of Ultrasound in Medicine (Sep 2018)

    Tags:
        entecavir Hepatitis

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OBJECTIVES To evaluate the dynamic changes of the aspartate aminotransferase (AST)-to-platelet ratio and transient elastography (FibroScan; Echosens, Paris, France) in predicting a histologic response in patients with chronic hepatitis B (CHB) after entecavir treatment.

METHODS A total of 148 patients with CHB were enrolled. Patient information was collected. All patients received liver biopsy and FibroScan before and after 96 weeks of entecavir treatment.

RESULTS Baseline liver biopsy results showed that there were 7 patients without liver fibrosis (fibrosis stage F0; 4.7%), 51 patients with mild liver fibrosis (F1; 34.5%), and 90 patients with advanced liver fibrosis (>F1; 60.9%). The liver stiffness value and AST-to-platelet ratio increased significantly as the METAVIR score of the patients increased from F0 to F4 (P < .001). After antiviral therapy for 96 weeks, the average liver stiffness value measured by FibroScan and the AST-to-platelet ratio showed a significant decrease. When we use a decreased liver stiffness value to predict a histologic response, the area under the receiver operating characteristic curve was 0.70 (95% confidence interval, 0.61-0.79; P < .001), and the sensitivity and specificity were 74.3% and 68.8%, respectively. The decrease of the AST-to-platelet ratio also could predict the histologic response of patients with CHB; the area under the receiver operating characteristic curve was 0.77 (95% confidence interval, 0.69-0.86; P < .001) with sensitivity of 76.2% and specificity of 70.2%. A multivariate analysis indicated that a high hepatitis B virus DNA viral load (odds ratio, 1.44; P = .04) and high METAVIR score (odds ratio, 1.38; P = .02) were independent risk factors for the histologic response.

CONCLUSIONS Both the AST-to-platelet ratio and FibroScan value can effectively predict a histologic response in patients with CHB during entecavir treatment. Therefore, they can be used to monitor these patients during antiviral treatment to avoid multiple liver biopsies.

StephenW

天冬氨酸氨基转移酶与血小板比值的动态变化和瞬时弹性成像预测恩替卡韦治疗后慢性乙型肝炎患者的组织学反应;孙杰，李,,孙曦，余鹤，刘烨;医学超声杂志（2018年9月）

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        恩替卡韦肝炎

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目的评估天冬氨酸氨基转移酶（AST）与血小板比率和瞬时弹性成像（FibroScan; Echosens，Paris，France）的动态变化，以预测恩替卡韦治疗后慢性乙型肝炎（CHB）患者的组织学反应。

方法共纳入148例CHB患者。收集患者信息。所有患者在恩替卡韦治疗96周前后均接受肝活检和FibroScan。

结果基线肝活检结果显示，7例无肝纤维化（纤维化分期F0; 4.7％），51例轻度肝纤维化（F1; 34.5％），90例晚期肝纤维化（> F1; 60.9％） 。随着患者METAVIR评分从F0增加到F4，肝硬度值和AST与血小板比值显着增加（P <.001）。在抗病毒治疗96周后，通过FibroScan测量的平均肝硬度值和AST与血小板比率显示显着降低。当我们使用降低的肝硬度值来预测组织学反应时，受试者工作特征曲线下面积为0.70（95％置信区间，0.61-0.79; P <.001），敏感性和特异性分别为74.3％和68.8 ％， 分别。 AST与血小板比值的降低也可预测CHB患者的组织学反应;受试者工作特征曲线下面积为0.77（95％置信区间，0.69-0.86; P <.001），敏感性为76.2％，特异性为70.2％。多变量分析表明，高乙型肝炎病毒DNA病毒载量（优势比，1.44; P = .04）和高METAVIR评分（优势比，1.38; P = .02）是组织学反应的独立危险因素。

结论在恩替卡韦治疗期间，AST-血小板比值和FibroScan值均能有效预测CHB患者的组织学反应。因此，它们可用于在抗病毒治疗期间监测这些患者以避免多次肝脏活组织检查。