乙型肝炎肝硬化抗病毒治疗后食管静脉曲张转归及其临床特征分析

Analysis of change in esophageal varices and clinical characteristics in hepatitis B virus-related cirrhosis after antiviral therapy

目的明确抗病毒治疗对乙型肝炎肝硬化患者食管静脉曲张的影响及其相关因素。方法选取乙型肝炎肝硬化前瞻性队列中具有抗病毒治疗前后胃镜检查结果的患者52例,基于食管静脉曲张程度将患者分为无、轻度、中-重度3组,对比各组抗病毒治疗后食管静脉曲张程度变化情况,对不同转归患者的临床特征(血小板、肝肾功能、肝脏硬度及病毒学应答情况)进行分析。计量资料采用独立样本t检验、单因素方差分析、Mann-WhitneyU检验、Kruskal-WallisH检验;计数资料采用χ^(2)检验。结果所有患者均接受以恩替卡韦为基础的抗病毒治疗,中位治疗时间3.1(2.5~4.4)年,无食管静脉曲张患者比例从30.8%增加至51.9%,轻度由40.4%降至30.8%,中-重度比例由28.8%降至17.3%(χ^(2)=14.067,P=0.001)。共有40.4%患者出现食管静脉曲张逆转,13.5%患者出现食管静脉曲张进展。中-重度患者进展率显著高于轻度及无食管静脉曲张患者(χ^(2)=28.126,P<0.001)60.0%的中-重度患者在抗病毒治疗后仍维持中-重度状态。在进展的中-重度食管静脉曲张患者中,基线血小板及5年平均变化率均显著低于不进展的患者(+3.3%与+34.1%,Z=7.00,P=0.027)。结论经过有效抗病毒治疗,乙型肝炎肝硬化合并食管静脉曲张患者能够获得食管静脉曲张逆转,但中-重度食管静脉曲张患者单纯接受抗病毒治疗仍有相当比例进展风险,血小板低且接受抗病毒治疗后血小板不显著上升是进展的临床征象。

Objective To clarify the efct and related factors of antiviral therapy on the change of esophageal varices in patients with hepatitis B virus-related cirrhosis.Methods Fifty-two cases with hepatitis B virus-related cirrhosis who underwent endoscopy before and after antiviral therapy were selected from prospective dohorts.Patients were divided into three groups:no,mild,and moderat-severe based on the degree of esophageal varces.The changes in the severity of esophageal varices in each group were compared after antiviral therapy.Clinical characteristics(platelet,liver and kidney function,liver stiffness,and virological response)of patients with different regressions were analyzed.Measurement data were analyzed by independent sample t-test,one-way ANOVA,Mann-Whitney U test and Kruskal-Wallis H test,and Chi-Square test was used for count data.Results All patients received entecavir-based antiviral therapy.The median treatment time was 3.1(2.5-4.4)years.The proportion of patients without esophageal varices increased from 30.8%to 51.9%,the proportion of mild esophageal varices decreased from 40.4%to 30.8%,and the proportion of patients with moderate-to-severe esophageal varices decreased from 28.8%to 17.3%(χ^(2)=14.067,P=0.001).A total of 40.4%of patients had esophageal varices regression,and 13.5%had esophageal varices progression.The progression rate was significantly higher in patients with moderate-severe esophageal varices than patients with mild and no esophageal varices(χ^(2)=28.126,P<0.001),and 60.0%of patients with moderate-severe esophageal varices still remained in moderate-severe state after antiviral treatment.Basceline platelet count and 5-year mean change rates were significantly lower in patients with progressive moderate-to-severe esophageal varices than in those without progression(+3.3%vs.+34.1%,Z=7.00,P=0.027).Conclusion After effective antiviral treatment,40.4%of patients with hepatitis B virus-related cirrhosis combined with esophageal varices has obtained csophageal varices regression,but those with moderate to severe esophageal varices still have a considerable risk of progression while receiving mono antiviral treatment only.Thrombocytopenia and without significant improving are the clinical signs of progression risk after receiving antiviral treatment.