慢性乙型肝炎E抗原阴性患者10年间纤维化进展。

StephenW

J Viral Hepat. 2019 Mar 21. doi: 10.1111/jvh.13095. [Epub ahead of print]
Fibrosis evolution in chronic hepatitis B E-antigen negative patients across a 10-year interval.
Mak LY1, Seto WK1,2, Hui RW1, Fung J1,2, Wong DK1,2, Lai CL1,2, Yuen MF1,2.
Author information

1
    Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
2
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.

Abstract

The degree of liver fibrosis in chronic hepatitis B (CHB) infection influences outcome and management. Existing data describing the long-term dynamic changes of liver fibrosis is limited. This study aimed to evaluate the evolution of liver fibrosis in CHB across a 10-year period. CHB patients with liver stiffness measurement (LSM) by transient elastography 10 years ago were recruited for follow-up LSM. Fibrosis stages were classified according to EASL-ALEH guidelines. Fibrosis progression/ regression was arbitrarily defined as ≥1 fibrosis stage change from baseline. 459 hepatitis B e antigen (HBeAg)-negative patients [224 untreated, 235 treated with nucleos(t)ide analogues (NAs)] were recruited. The mean age at baseline LSM was 41.7±9.0 years (56.2% male). Over 10 years, the proportion of patients with advanced fibrosis/cirrhosis significantly reduced from 16.3% to 5.7% (p<0.001). Fibrosis progression and regression was observed in 8.7% and 37.5%, respectively. No treatment with NAs (OR 2.259, 95%CI: 1.032-4.945), metabolic syndrome (OR 4.379, 95%CI: 1.128-16.999) and hepatic steatosis (OR 7.799, 95%CI: 2.271-26.776) were associated with fibrosis progression. Liver stiffness decline demonstrated positive correlation with the time after HBsAg seroclearance (r= -0.50, p<0.001). Median liver stiffness were higher both at baseline (14.0 vs. 6 kPa, p<0.001) and 10-year (9.1 vs. 4.9 kPa, p<0.001) in patients with cirrhosis-related complications/HCC compared with those without. In conclusion CHB-related liver fibrosis changed dynamically across 10 years. Metabolic syndrome and hepatic steatosis were associated with fibrosis progression, while antiviral therapy was associated with fibrosis regression. Patients with HBsAg seroclearance demonstrated time-dependent decline in liver stiffness. This article is protected by copyright. All rights reserved.

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

fatty liver; hepatitis B; liver fibrosis; metabolic syndrome

PMID:
    30895682
DOI:
    10.1111/jvh.13095

StephenW

J病毒肝病。 2019年3月21日doi：10.1111 / jvh.13095。 [印刷前的电子版]
慢性乙型肝炎E抗原阴性患者10年间纤维化进展。
Mak LY1，Seto WK1,2，Hui RW1，Fung J1,2，Wong DK1,2，Lai CL1,2，Yuen MF1,2。
作者信息

1
香港大学玛丽医院香港大学医学系。
2
香港大学肝脏研究国家重点实验室。

抽象

慢性乙型肝炎（CHB）感染的肝纤维化程度影响结果和管理。描述肝纤维化的长期动态变化的现有数据是有限的。本研究旨在评估10年期间CHB肝纤维化的演变。 10年前通过瞬时弹性成像测量肝脏硬度测量（LSM）的CHB患者被招募用于随访LSM。纤维化阶段/研究被任意定义为≥1纤维化阶段从基线变化。招募了459名乙型肝炎e抗原（HBeAg）阴性患者[224名未治疗患者，235名用核苷（酸）类似物（NAs）治疗]。基线LSM的平均年龄为41.7±9.0岁（男性为56.2％）。超过10年，晚期纤维化/肝硬化患者的比例从16.3％显着降低至5.7％（p <0.001）。纤维化进展和消退分别为8.7％和37.5％。 NAs治疗（OR 2.259,95％CI：1.032-4.945），代谢综合征（OR 4.379,95％CI：1.128-16.999）和肝脂肪变性（OR 7.799,95％CI：2.271-26.776）与纤维化无关进展。肝硬度下降的艺术品与HBsAg血清清除后的时间呈正相关（r = -0.50，p <0.001）。肝硬化相关并发症/ HCC患者的基线（14.0 vs. 6 kPa，p <0.001）和10年（9.1 vs. 4.9 kPa），p <0.001）的中位肝硬度均高于无肝硬化患者。总之，CHB相关的肝纤维化在10年内动态变化。代谢综合征和肝脏脂肪变性与纤维化进展有关，而抗病毒治疗与纤维化有关.HBsAg血清清除患者的研究显示肝硬度随时间下降。本文受版权保护。

本文受版权保护。版权所有。
关键词：

脂肪肝;乙型肝炎;肝纤维化;

结论：
30895682
DOI：
10.1111 / jvh.13095