EASL2019 THU-220 肝硬度的早期急剧下降预示组织学逆转 恩替卡

StephenW

THU-220
Early steep decline of liver stiffness predicts histological reverse of
fibrosis in chronic hepatitis B patients treated with entecavir
Yuanyuan Kong1, Hong You1, Jidong Jia1, Regression of HBV-induced
Liver Fibrosis Research Group China2. 1Beijing Friendship Hospital,
Capital Medical University, Beijing, China; 2Hospitals, Beijing, China
Email: [email protected]
Background and aims: Whether dynamic changes of liver stiffness
measurement (LSM) could predict the reversibility of fibrosis remains
unknown. Therefore, we evaluated the utility of LSM declining for
predicting histological changes of fibrosis in patients with chronic
hepatitis B (CHB) on antiviral therapy.
Method: In a prospective cohort of CHB patients treated with
entecavir, virology, biochemistry and LSM were measured at baseline
and every 6 months. Liver biopsies were conducted at both baseline
and 18-month treatment. Fibrosis regression was defined by two
criteria: (1) Ishak decreasing ≥1 stage, (2) Ishak decreasing ≥1 stage
or predominantly regressive by posttreatment P-I-R classification.
Piecewise linear mixed-effects model and ROC analysis were used to
evaluate the dynamic changes of LSM and its predictive value for
histological reversibility.
Results:We found that at month 18 of antiviral therapy, liver fibrosis
was reserved in 86 patients of 212 (40.6%) CHB patients by Ishak
reversal criterion. Overall, LSM declining was associated with
attenuation of Ishak stage. The rate of LSM declining in the first 6
months was significantly faster in patients with fibrosis reverse
(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 stage as well as baseline LSM, PLT, ALB and their changes
during the first 6 months could predict the histological reverse
(AUROCIshak = 0.74, 95% CI: 0.67-0.80; AUROCIshak/PIR = 0.81, 95%
CI: 0.74-0.87).
Conclusion:We concluded that dynamic changes of LSM during the
first 6 months of entecavir therapy could predict histological
reversibility of liver fibrosis in CHB patients.

StephenW

THU-220
肝硬度的早期急剧下降预示组织学逆转
恩替卡韦治疗慢性乙型肝炎患者的纤维化
媛媛康1，洪友1，冀东佳1，HBV诱导的回归
中国肝纤维化研究组2。 1北京友谊医院
首都医科大学，中国北京; 2医院，北京，中国
电子邮件：[email protected]
背景和目的：肝脏硬度是否动态变化
测量（LSM）可以预测纤维化残留的可逆性
未知。因此，我们评估了LSM下降的效用
预测慢性乙型肝炎患者纤维化的组织学变化
乙型肝炎（CHB）抗病毒治疗。
方法：在一组前瞻性CHB患者中接受治疗
在基线时测量恩替卡韦，病毒学，生物化学和LSM
每6个月一次。在两个基线进行肝脏活组织检查
和18个月的治疗。纤维化退化由两个定义
标准：（1）Ishak减少≥1阶段，（2）Ishak减少≥1阶段
或通过治疗后P-I-R分类主要是退行性的。
分段线性混合效应模型和ROC分析用于
评估LSM的动态变化及其预测值
组织学可逆性。
结果：我们发现在抗病毒治疗的第18个月，肝纤维化
Ishak对212例（40.6％）CHB患者的患者进行了保留
逆转标准。整体而言，LSM下跌与之相关
Ishak阶段的衰减。 LSM在前6个月下降
纤维化逆转患者的月数明显加快
（ΔLSM％Ishak = -2.19％/月，p = 0.0025;ΔLSM％Ishak / PIR = -2.56％/
月，p = 0.0004）。基于基线FIB-4和基线的预测模型
Ishak阶段以及基线LSM，PLT，ALB及其变化
在前6个月可以预测组织学逆转
（AUROCIshak = 0.74,95％CI：0.67-0.80; AUROCIshak / PIR = 0.81,95％
CI：0.74-0.87）。
结论：我们得出结论：LSM期间LSM的动态变化
恩替卡韦治疗的前6个月可以预测组织学
CHB患者肝纤维化的可逆性。