剪切波弹性成像动态监测预测慢性乙型肝炎失代偿期肝硬化

StephenW

剪切波弹性成像动态监测预测慢性乙型肝炎失代偿期肝硬化患者的预后
叶俊兆1、黄杨2、孙艳红3、邵从祥1、张胜红1、王伟2、毕惠中1
隶属关系
隶属关系

    1
    广州中山大学附属第一医院消化内科。
    2
    中国广州中山大学附属第一医院超声科。
    3
    广州中山大学附属第一医院检验科。

    PMID：34926657 PMCID：PMC8640914 DOI：10.21037/atm-21-3142

抽象的

背景：二维剪切波弹性成像 (2D-SWE) 可用于准确评估慢性乙型肝炎 (CHB) 的显着肝纤维化。然而，失代偿期肝硬化患者是否可以从 2D-SWE 监测中获益仍不清楚。我们旨在评估 2D-SWE 测量的动态变化与 CHB 相关失代偿性肝硬化预后之间的关联。

方法：我们从 2015 年 2 月至 2018 年 12 月的一项临床试验（注册号：ChiCTR-DCD-15006000）中前瞻性地招募了 149 名连续初治的失代偿性肝硬化 CHB 患者。2D-SWE 以 48 周为间隔进行，直到 2020 年 12 月。肝脏相关事件 (LRE) 通过电子病历和电话采访记录。

结果：未发生 LREs 的患者在抗病毒治疗后肝脏硬度测量 (LSM) 水平持续降低，而 LREs 患者显示出 LSM 改变的波动趋势。低预处理 2D-SWE LSM、Δ% 2D-SWE LSM 病毒前控制和 Δ% 2D-SWE LSM 后处理的特征在于与这些参数的高水平相似的预后能力。在抗病毒治疗后的多元 Cox 回归模型中，治疗后 2D-SWE LSM 与 LRE 独立相关[风险比 (HR) = 1.05； 95% 置信区间 (CI)：1.02-1.08，P=0.0007 和 1.11； 95% CI：1.04-1.18，P=0.0026]。接受者操作特征 (ROC) 曲线分析表明，在所有其他变量中，包括 2D-SWE 参数和血清纤维化标志物（曲线下面积 = 0.75，P < 0.001）。

结论：最后一次随访 LSM 而非治疗前或 2D-SWE 的动态变化可作为 LRE 的有力预测因子，表明序贯监测可能有益于预测预后。

关键词：二维剪切波弹性成像（2D-SWE）；慢性乙型肝炎（CHB）；失代偿性肝硬化；肝脏硬度测量（LSM）；预测。

2021 年转化医学年鉴。版权所有。

StephenW

Dynamic monitoring with shear wave elastography predicts outcomes of chronic hepatitis B patients with decompensated cirrhosis
Junzhao Ye  1 , Yang Huang  2 , Yanhong Sun  3 , Congxiang Shao  1 , Shenghong Zhang  1 , Wei Wang  2 , Bihui Zhong  1
Affiliations
Affiliations

    1
    Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
    2
    Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
    3
    Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

    PMID: 34926657 PMCID: PMC8640914 DOI: 10.21037/atm-21-3142

Abstract

Background: Two-dimensional shear wave elastography (2D-SWE) can be used to accurately assess significant liver fibrosis in chronic hepatitis B (CHB). However, whether those with decompensated cirrhosis could benefit from surveillance with 2D-SWE remains unclear. We aimed to evaluate the association between dynamic changes in 2D-SWE measurements and the prognosis of CHB-related decompensated cirrhosis.

Methods: We prospectively enrolled 149 consecutive treatment-naive CHB patients with decompensated cirrhosis from a clinical trial (registration number: ChiCTR-DCD-15006000) from February 2015 to December 2018. 2D-SWE was performed at 48-week intervals until December 2020. Liver-related events (LREs) were recorded through electronic medical records and telephone interviews.

Results: The liver stiffness measurement (LSM) levels persistently reduced after antiviral therapy in patients who did not develop LREs, while patients with LREs showed a fluctuating trend of LSM alterations. Low pre-treatment 2D-SWE LSM, ∆% 2D-SWE LSM pre-virus control, and ∆% 2D-SWE LSM pre-post treatment were characterized by similar prognostic abilities as high levels of these parameters. Post-treatment 2D-SWE LSM was independently correlated with LREs in multivariate Cox regression models after antiviral treatments [hazard ratio (HR) =1.05; 95% confidence interval (CI): 1.02-1.08, P=0.0007 and 1.11; 95% CI: 1.04-1.18, P=0.0026]. Receiver operating characteristic (ROC) curve analysis identified that post-treatment 2D-SWE LSM exhibited the best predictive power for LREs among all the other variables, including parameters of 2D-SWE and serum fibrosis markers (area under the curve =0.75, P<0.001).

Conclusions: The last follow-up LSM, rather than pre-treatment or dynamic changes in 2D-SWE serves as a powerful predictor of LREs, suggesting that sequential monitoring may be beneficial to predicting prognosis.

Keywords: Two-dimensional shear wave elastography (2D-SWE); chronic hepatitis B (CHB); decompensated cirrhosis; liver stiffness measurements (LSMs); prognosis.

2021 Annals of Translational Medicine. All rights reserved.

StephenW

https://atm.amegroups.com/article/viewFile/80579/pdf