慢性乙型肝炎病毒感染者肝脏弹性长期动态演变的观察

Long-term dynamic change of liver elasticity in chronic hepatitis B virus infection

目的慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者接受抗病毒治疗能阻滞、延缓或逆转肝纤维化,但未接受抗病毒治疗患者的肝纤维化演变规律仍有待研究。本研究观察了未达到抗病毒指征患者肝脏硬度值(liver stiffness measure-ment,LSM)、病毒学和生化学的长期动态变化。方法回顾性纳入2012年9月至2018年3月在西安交通大学第一附属医院就诊被诊断为慢性HBV感染、未达到抗病毒标准、有2年以上临床资料的患者220例。根据基线与随访期间LSM动态变化,分为缓解组、无进展组和进展组,分析各组患者的病毒学、生化学特征。结果153例(69.5%)患者LSM分级无进展,谷丙转氨酶(alanine aminotransferase,ALT)、HBV DNA、乙型肝炎表面抗原(HBsAg)除少数存在升高或略微下降外,绝大多数维持在相对稳定状态;该组89.5%(137/153)的患者基线LSM为F0级。58例(26.4%)患者LSM分级自发性改善,LSM年变化−0.460 kPa,基线ALT为1~2 ULN的患者LSM下降与ALT正常组患者相比差异有统计学意义;该组82.8%(48/58)的患者基线LSM为F1~F3级。9例(4.1%)患者LSM分级进展,但不能用病毒复制或肝脏炎症解释。结论未达到抗病毒指征的HBV感染者,基线LSM为F0级患者大部分无进展,LSM为F1~F3患者在随访期间LSM下降,4.1%患者出现LSM进展。

Objective Antiviral treatments could benefit chronic hepatitis B(CHB)patients with the regression or improvement of liver fibrosis.However,the degree of dynamic change of liver fibrosis for patients who had not received antiviral treatment remained to be studied.The current study aimed to observe the long-term variation of liver stiffness measurement(LSM),virological and biochemical response on patients without standard antiviral therapy.Methods A total of 220 patients who were diagnosed with chronic HBV infection,who had not reached the standard of antiviral therapy,and completed a follow-up date of over 2 years in the First Affiliated Hospital of Xi’an Jiaotong University from 2012 to 2018 were retrospectively enrolled.According to the changes of LSM in baseline and follow-up period,the patients were divided into regression group,non-progressive group,and progressive group.The virological and biochemical characteristics of each group were analyzed.Results Among the 220 patients,153 patients(69.5%)had no progress in LSM degree.Alanine aminotransferase(ALT),HBV DNA,and HBsAg in a few patients increased or slightly decreased,while the vast majority remained in a relatively stable state.89.5%(137/153)of the non-progressive patients were in grade F0.In addition,58 patients showed spontaneous improvement with a decreasing rate of 0.460 kPa per year.Patients with ALT of 1-2 ULN had a statistically significant decrease in LSM improvement compared to patients with normal ALT.82.8%of the LSM-improving patients showed baseline LSM of F1-F3.Only 9 patients showed LSM deterioration,however,which could not be explained by virus replication or necroinflammatory activity.Conclusions For patients unsatisfying standard antiviral therapy,most patients with baseline LSM of F0 grade fail to progress,and patients with baseline LSM of F1-F3 show a decrease during follow-up,LSM progression occurs in 4.1%of patients.