AASLD2018[1065]肝硬度相关的临床因素 78周抗病毒治疗后的改善

StephenW

1065
Clinical Factors Associated with Liver Stiffness
Improvement after 78 Week Antiviral Therapy in
Chronic Hepatitis B Patients
Xiao-Qin Dong, Zhao Wu, Liang Miao, Wan-Na Yang, Hong
Zhao and Guiqiang Wang, Infectious Diseases, Peking
University First Hospital
Background: Liver stiffness measurement (LSM), which
performed by transient elastography (TE, FibroScan®), has
gained popularity in non-invasive liver fibrosis assessment
in patients with chronic liver diseases. As LSM has superb
patient acceptance it has been widely used in monitoring liver
fibrosis progression and regression in the individual case, but
the accuracy of LSM in fibrosis monitoring during hepatitis B
virus (HBV) infection has not been well established. We aimed
to analyse the dynamics of LSM and compare the accuracy
of LSM in monitoring fibrosis changes during antiviral therapy
in chronic hepatitis B (CHB) patients. Methods: A total of 556
Chinese treatment-naïve CHB patients were enrolled in this
study, 183 of which had reliable paired LSM and liver biopsies
at baseline and week 78, and 250 of which had intact LSM
and liver biopsy at week 78. Serologic detection, LSM and
Liver biopsy were done within one month. Necroinflammation
and fibrosis were assessed with the Ishak scoring system.
The detailed clinical trial protocol has been registered
(NCT01962155 and ChiCTR-DDT-13003724). Results: In
treatment-naïve CHB patients, area under receiver operating
characteristics curves (AUROCs) of LSM for significant
fibrosis (F0-2 vs F3–6), advanced fibrosis (F0–3 vs F4–6)
and liver cirrhosis (F0–4 vs F5-6) was 0.84 (95% CI: 0.80-
0.87), 0.87 (95% CI: 0.84-0.89) and 0.83 (95% CI: 0.76-0.91)
respectively. Patients with the same fibrosis stage but higher
hepatitis B core antibody (anti-HBc) levels tend to have higher
LSM, and the diagnostic performance for significant fibrosis
was best when anti-HBc < 3.7 log10 IU/ml. Liver stiffness
decreased rapidly (−3.8 [1.6-8.6] kPa/78 weeks) from 11.3
(7.8-16.7) kPa at baseline to 6.4 (5.1-8.8) kPa at week 78.
More importantly, the decline of liver stiffness was in parallel
with baseline liver biochemistry levels, anti-HBc levels, alpha
fetoprotein (AFP) levels and the modified Knodell histology
activity index (HAI) , but not with baseline liver fibrosis
stages (Figure). Interestingly, After 78 week antiviral therapy,
AUROCs of LSM for significant fibrosis, advanced fibrosis and
liver cirrhosis were comparable with that in treatment-naïve
CHB patients. Conclusion: In CHB patients, LSM is useful
in monitoring liver fibrosis progression and regression before
and after antiviral therapy. The dynamic changes of LSM were
associated with the course of liver inflammation improvement
during 78 week antiviral thearpy.

StephenW

1065
肝硬度相关的临床因素
78周抗病毒治疗后的改善
慢性乙型肝炎患者
董晓琴，赵武，梁淼，杨万娜，洪
赵和王贵强，北京传染病研究所
大学第一医院
背景：肝硬度测量（LSM），其中
由瞬态弹性成像（TE，FibroScan®）执行
在非侵入性肝纤维化评估中获得了普及
在慢性肝病患者中。由于LSM非常棒
患者接受它已被广泛用于监测肝脏
个别情况下纤维化进展和消退，但是
LSM在乙型肝炎病毒监测中的准确性
病毒（HBV）感染尚未确定。我们的目标
分析LSM的动态并比较精度
LSM在抗病毒治疗期间监测纤维化变化
在慢性乙型肝炎（CHB）患者中。方法：共556
中国未接受过治疗的CHB患者参加了此项研究
研究中，其中183例具有可靠的配对LSM和肝脏活组织检查
在基线和第78周，其中250个具有完整的LSM
在第78周进行肝活检。血清学检测，LSM和
肝脏活组织检查在一个月内完成。坏死性炎症
用Ishak评分系统评估纤维化。
详细的临床试验方案已经注册
（NCT01962155和ChiCTR-DDT-13003724）。结果是
治疗初始CHB患者，接受者手术区域
LSM的特征曲线（AUROCs）显着
纤维化（F0-2 vs F3-6），晚期纤维化（F0-3 vs F4-6）
肝硬化（F0-4 vs F5-6）为0.84（95％CI：0.80-
0.87），0.87（95％CI：0.84-0.89）和0.83（95％CI：0.76-0.91）
分别。具有相同纤维化阶段但更高的患者
乙肝核心抗体（抗-HBc）水平往往较高
LSM，以及显着纤维化的诊断性能
抗-HBc <3.7 log10 IU / ml时最佳。肝硬度
从11.3迅速下降（-3.8 [1.6-8.6] kPa / 78周）
（7.8-16.7）基线时的kPa为78周时的6.4（5.1-8.8）kPa。
更重要的是，肝硬度的下降是平行的
基线肝脏生化水平，抗-HBc水平，α
胎儿蛋白（AFP）水平和修饰的Knodell组织学
活动指数（HAI），但与基线肝纤维化无关
阶段（图）。有趣的是，经过78周的抗病毒治疗，
LSM的AUROCs显着纤维化，晚期纤维化和纤维化
肝硬化与未接受治疗的肝硬化相当
CHB患者。结论：在CHB患者中，LSM是有用的
在监测肝纤维化进展和消退之前
并经过抗病毒治疗。 LSM的动态变化是
与肝脏炎症改善的过程相关
在78周抗病毒治疗期间。