PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic hepatitis B virus (HBV) infection patients who do not fulfill the typical treatment indications should be followed up. This study aimed to evaluate the risk of liver fibrosis progression (LFP) and assess the role of noninvasive tests (NITs) of liver fibrosis in monitoring LFP in these patients.
UNASSIGNED: A total of 116 patients with active HBV replication, persistently normal or minimally elevated alanine aminotransferase (ALT) levels, and no or mild hepatic necroinflammation or fibrosis based on liver biopsy tests at baseline and followed by a repeated liver biopsy assessment during follow-up. LFP was defined as increase in METAVIR fibrosis score by 1 score or more.
UNASSIGNED: Among 116 patients, 40 (34.5%) progressed by at least one fibrosis stage, 16 (13.8%) progressed by at least two fibrosis stages at a median follow-up interval of 27 months (IQR: 12-36). Multivariate analysis confirmed the significant association of an increase in liver stiffness measurement (LSM) value with LFP on histology (p =0.005). The AUROC of LSM value increase rate is significantly higher than that of serum-based NITs of liver fibrosis for the prediction of LFP (p < 0.05). An increase in LSM by 20% is the optimal cutoff for the prediction of LFP.
UNASSIGNED: LFP is non-negligible in patients with active HBV replication, persistently normal or minimally elevated ALT, and initially no or minimal hepatic necroinflammation or fibrosis. Serial LSM tests would be more reliable in identifying LFP than serum-based NITs, and easier to obtain than serial liver biopsy tests.
UNASSIGNED: A total of 116 patients with active HBV replication, persistently normal or minimally elevated alanine aminotransferase (ALT) levels, and no or mild hepatic necroinflammation or fibrosis based on liver biopsy tests at baseline and followed by a repeated liver biopsy assessment during follow-up. LFP was defined as increase in METAVIR fibrosis score by 1 score or more.
UNASSIGNED: Among 116 patients, 40 (34.5%) progressed by at least one fibrosis stage, 16 (13.8%) progressed by at least two fibrosis stages at a median follow-up interval of 27 months (IQR: 12-36). Multivariate analysis confirmed the significant association of an increase in liver stiffness measurement (LSM) value with LFP on histology (p =0.005). The AUROC of LSM value increase rate is significantly higher than that of serum-based NITs of liver fibrosis for the prediction of LFP (p < 0.05). An increase in LSM by 20% is the optimal cutoff for the prediction of LFP.
UNASSIGNED: LFP is non-negligible in patients with active HBV replication, persistently normal or minimally elevated ALT, and initially no or minimal hepatic necroinflammation or fibrosis. Serial LSM tests would be more reliable in identifying LFP than serum-based NITs, and easier to obtain than serial liver biopsy tests.
摘要：
■不符合典型治疗指征的慢性乙型肝炎病毒（HBV）感染患者应进行随访。本研究旨在评估肝纤维化进展（LFP）的风险，并评估肝纤维化的非侵入性测试（NIT）在监测这些患者的LFP中的作用。
■共有116例HBV复制活跃的患者，丙氨酸转氨酶（ALT）水平持续正常或最低限度升高，根据基线时的肝活检检查，没有或轻度肝坏死性炎症或纤维化，随后在随访期间进行重复的肝活检评估。LFP定义为METAVIR纤维化评分增加1分或更多。
■在116名患者中，40（34.5％）进展到至少一个纤维化阶段，16（13.8％）在27个月的中位随访间隔中进展至少两个纤维化阶段（IQR：12-36）。多变量分析证实了肝脏硬度测量（LSM）值增加与组织学上的LFP的显着关联（p=0.005）。LSM值的AUROC升高率显著高于血清NIT对LFP的预测(p<0.05)。LSM增加20%是预测LFP的最佳截止值。
■LFP在HBV复制活跃的患者中是不可忽视的，持续正常或最低限度升高的ALT，最初没有或轻微的肝坏死性炎症或纤维化。串行LSM测试在识别LFP方面比基于血清的NIT更可靠，比连续的肝活检更容易获得。
■共有116例HBV复制活跃的患者，丙氨酸转氨酶（ALT）水平持续正常或最低限度升高，根据基线时的肝活检检查，没有或轻度肝坏死性炎症或纤维化，随后在随访期间进行重复的肝活检评估。LFP定义为METAVIR纤维化评分增加1分或更多。
■在116名患者中，40（34.5％）进展到至少一个纤维化阶段，16（13.8％）在27个月的中位随访间隔中进展至少两个纤维化阶段（IQR：12-36）。多变量分析证实了肝脏硬度测量（LSM）值增加与组织学上的LFP的显着关联（p=0.005）。LSM值的AUROC升高率显著高于血清NIT对LFP的预测(p<0.05)。LSM增加20%是预测LFP的最佳截止值。
■LFP在HBV复制活跃的患者中是不可忽视的，持续正常或最低限度升高的ALT，最初没有或轻微的肝坏死性炎症或纤维化。串行LSM测试在识别LFP方面比基于血清的NIT更可靠，比连续的肝活检更容易获得。
