Interpretation of liver stiffness measurement‐based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2‐year prospective study

作者：Xie Liang, Qing Xie, Dianhui Tan, Qin Ning, Junqi Niu, Xue–Fan Bai, Shunpeng Chen, Jun Cheng, Yang Yu, Hui Wang, Min Xu, Guangfeng Shi, M. Wan, X. Chen, Hong Tang, Jifang Sheng, Xiaoguang Dou, Junping Shi, Hong Ren, M. Wang, H. Zhang, Zhiliang Gao, C. Chen, Hong Ma, Y. Chen, Rong Fan, Jian Sun, Jidong Jia, Jinlin Hou · 发表于：Journal of Viral Hepatitis · 年份：2017 · DOI：10.1111/jvh.12814 · 被引用次数：45 · 研究领域：Hepatitis B Virus Studies、Liver Disease Diagnosis and Treatment、Hepatitis C virus research

Summary Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan ® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen‐positive treatment‐naive patients receiving telbivudine‐based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (−2.2 kP a/24 weeks) in parallel with alanine aminotransferase ( ALT ) from 8.6 (2.6‐49.5) kP a at baseline to 6.1 (2.2‐37.4) kP a at week 24. Interestingly, liver stiffness decreased slowly (−0.3 kP a/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kP a, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0‐2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52‐week liver stiffness from baseline was independently associated with 1...