Unreliable Estimation of Fibrosis Regression During Treatment by Liver Stiffness Measurement in Patients With Chronic Hepatitis B

作者：Dong Ji, Yan Chen, Qinghua Shang, Huabao Liu, Lin Tan, Jing Wang, Yong‐Ping Chen, Qin Li, Qinghua Long, Laicheng Song, Jiang Li, Guangming Xiao, Zujiang Yu, Liang Chen, Xiaoyu Hu, Xiaodong Wang, Da Chen, Zhiqin Li, Zheng Dong, Guofeng Chen, Yongping Yang · 发表于：The American Journal of Gastroenterology · 年份：2021 · DOI：10.14309/ajg.0000000000001239 · 被引用次数：35 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis、Liver Diseases and Immunity

INTRODUCTION: Little reliable evidence has been reported regarding usefulness of liver stiffness measurement (LSM) for monitoring the hepatic fibrosis changes during treatment. We aimed to assess the association between changes in LSM and histological outcomes in patients with chronic hepatitis B. METHODS: In this prospective multicenter study, 727 treatment-naive patients receiving entecavir-based therapy, who underwent paired biopsies at treatment baseline and week 72, were analyzed. Changes in LSM were defined as ≥30% decrease, minor change, and ≥30% increase. Multivariate logistic regression was used to estimate odds ratios (ORs) of changes in LSM on clinical outcomes accounting for regression to the mean. A new on-treatment LSM threshold was established by receiver operating curve. RESULTS: Overall regression of fibrosis, improvement of inflammation, significant histological response, virologic response, alanine aminotransferase normalization, and hepatitis B e antigen seroconversion were 51.2%, 74.4%, 22.0%, 86.0%, 83.5%, and 13.3%, respectively. The association between changes in LSM and improvement of inflammation was nonlinear (P = 0.012). LSM decrease ≥30% was associated with regression of fibrosis (OR 1.501, 95% confidence interval [CI] 1.073-2.099, P = 0.018), significant histological response (OR 1.726, 95% CI 1.124-2.652, P = 0.013), and alanine aminotransferase normalization (OR 2.149, 95% CI 1.229-3.757, P = 0.007). After adjusting for regression to the mean, ...