慢性乙型肝炎治疗后肝脏硬度值变化与纤维化逆转的关系

Relationship Between Changes in Liver Stiffness Value and Fibrosis Reversal after Treatment for Chronic Hepatitis B

目的:探究慢性乙型肝炎(CHB)患者治疗后肝脏硬度值(LSM)变化与肝纤维化逆转的关系。方法:选择2020年4月至2021年8月期间山东大学第二医院成武分院收治的CHB患者80例作为研究对象,患者均接受过抗病毒治疗,治疗后按照是否肝纤维化逆转分为两组,分别为逆转组(38例)与非逆转组(42例)。收集患者的基线资料[年龄、性别、饮酒史、吸烟、体质量指数(BMI)]及治疗前实验室生化指标,并行超声检测LSM,计算谷草转氨酶与血小板数比值(APRI)、基于4项因素的肝纤维化指数(FIB-4)。采用多因素logistic回归分析纤维化逆转的影响因素,观察LSM是否对肝纤维化逆转产生影响。结果:逆转组与非逆转组在血小板数(PLT)>300×10^(9)·L^(-1)、乙型肝炎病毒脱氧核糖核酸(HBV DNA)水平、LSM分级、ΔLSM方面比较,差异均具有统计学意义(P<0.05)。多因素logistic回归分析结果表明,治疗前PLT>300×10^(9)·L^(-1)及治疗前LSM 9.4~17.0 kPa、LSM>17.0 kPa是肝纤维化逆转的危险因素(OR>1,P<0.05),HBV DNA 4.0~7.0 lg IU·mL^(-1)、HBV DNA>7.0 lg IU·mL^(-1)不是肝纤维化逆转的独立影响因素(P>0.05)。ΔLSM 5~10 kPa、ΔLSM>10 kPa是肝纤维逆转的保护因素(OR<1,P<0.05)。结论:治疗前PLT>300×10^(9)·L^(-1)及治疗前LSM 9.4~17.0 kPa、LSM>17.0 kPa是肝纤维化逆转的危险因素,ΔLSM 5~10 kPa、ΔLSM>10 kPa是肝纤维逆转的保护因素。

Objective To investigate the relationship between the change of liver stiffness measurement(LSM)and the reversal of liver fibrosis in chronic hepatitis B(CHB)patients after treatment.Methods A-total of 80 patients with CHB admitted to Chengwu Branch of the Second Hospital of Shandong University between April 2020 and August 2021 were selected as study subjects,all of whom had received antiviral treatment and were divided into two groups according to whether they had reversed liver fibrosis after treatment,namely the reversal group(38 patients)and the non-reversal group(42 patients).Baseline data[age,gender,history of alcohol consumption,smoking,body mass index(BMI)]and pretreatment laboratory biochemical indexes were collected,and ultrasound was performed to detect the LSM,to calculate the azotransferase to platelet count ratio(APRI),and the liver fibrosis index based on 4 factors(FIB-4).Multifactorial logistic regression was used to analyse the influencing factors of fibrosis reversal and to observe whether LSM had an effect on liver fibrosis reversal.Results The differences between the reversal group and the non-reversal group in terms of platelet count(PLT)>300×10^(9)·L^(-1),hepatitis B virus deoxyribonucleic acid(HBV DNA)level,LSM grading,andΔLSM were statistically significant(P<0.05).The results of multifactorial logistic regression analysis showed that pretreatment PLT>300×10^(9)·L^(-1) and pretreatment LSM 9.4~17.0 kPa,LSM>17.0 kPa were the risk factors for hepatic fibrosis reversal(OR>1,P<0.05),HBV DNA 4.0~7.0 lg IU·mL^(-1)、HBV DNA>7.0 lg IU·mL^(-1) were not independent influencing factors for liver fibrosis reversal(P>0.05).ΔLSM 5~10 kPa andΔLSM>10 kPa were protective factors for liver fiber reversal(OR<1,P<0.05).Conclusion Pre-treatment PLT>300×10^(9)·L^(-1) and pre-treatment LSM 9.4~17.0 kPa and LSM>17.0 kPa were risk factors for hepatic fibrosis reversal,andΔLSM 5~10 kPa andΔLSM>10 kPa were protective factors for hepatic fiber reversal.