J Viral Hepat. 2019 Jan 9. doi: 10.1111/jvh.13058. [Epub ahead of print]
Early steep decline of liver stiffness predicts histological reversal of fibrosis in chronic hepatitis B patients treated with entecavir.
Kong Y1, Sun Y1, Zhou J1, Wu X1, Chen Y2, Piao H3, Lu L4, Ding H5, Nan Y6, Jiang W7, Xu Y8, Xie W9, Li H10, Feng B11, Shi G12, Chen G13, Li H14, Zheng H15, Cheng J16, Wang T17, Liu H18, Fudong L18, Chen S17, Mao Y19, Sun J20, Chen T21, Han T22, Han Y23, Wang L1, Ou X1, Zhang H24, Jia J1, You H1.
Author information
1
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing, China.
2
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
3
Infectious Disease Department, Affiliated Hospital of Yanbian University, Yanji, Jilin, China.
4
Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
5
Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
6
Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
7
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
8
Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
9
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
10
Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China.
11
Hepatology Institution, Peking University People's Hospital, Beijing, China.
12
Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
13
Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing, China.
14
Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People's Armed Police Force, Tianjin, China.
15
Department of Infectious Disease, the Fifth Hospital of Shijiazhuang City, Shijiazhuang, Hebei, China.
16
Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
17
Pathology Department, China-Japan Friendship Hospital, Beijing, China.
18
Pathology Department, Beijing Youan Hospital, Capital Medical University, Beijing, China.
19
Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
20
Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
21
Department of Infectious Disease, Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
22
Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China.
23
Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China.
24
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
Abstract
It is unknown whether dynamic changes of liver stiffness measurement (LSM) can predict the reversibility of fibrosis. Therefore, we evaluated the utility of LSM changes in predicting histological changes of fibrosis in patients with chronic hepatitis B (CHB) on antiviral therapy. In a prospective cohort of CHB patients treated with entecavir, virological and biochemical measurement along with LSM were measured at baseline and every 6 months. Liver biopsies were conducted at baseline and month 18 of treatment. Fibrosis regression was defined by two criteria: (1) Ishak score decrease ≥1 stage, (2) Ishak score decrease ≥1 stage or predominantly regressive by posttreatment P-I-R classification. The dynamic changes of LSM and its predictive value for histological reversibility were evaluated with piecewise linear mixed-effects model and ROC analysis. We found that at month 18 of antiviral therapy, liver fibrosis was reserved in 86 of 212 (40.6%) CHB patients by Ishak reversal criterion. Overall, a decline in LSM was associated with attenuation of Ishak score. The rate of LSM decline in the first 6 months was significantly faster in patients with fibrosis reversal (ΔLSM%Ishak =-2.19%/month, p=0.0025; ΔLSM%Ishak/ PIR =-2.56%/month, p=0.0004). The predictive model based on baseline FIB-4 and Ishak score as well as baseline LSM, PLT, ALB and their changes during the first 6 months could predict histological reversal (AUROCI shak =0.74, 95% CI: 0.67-0.80; AUROCI shak/ PIR =0.81, 95% CI: 0.74-0.87). We conclude that in CHB patients changes in LSM during the first 6 months of entecavir therapy can predict histological reversibility of liver fibrosis at month 18 of antiviral therapy. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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