Zopf Steffen, Rösch Lara, Konturek Peter C, Goertz Ruediger S, Neurath Markus F, Strobel Deike
Medical Department 1, University of Erlangen-Nuremberg, Erlangen, Germany.
Department of Internal Medicine 2, Thüringen Kliniken "Georgius Agricola, Saalfeld, Germany.
Med Sci Monit. 2016 Sep 30;22:3500-3505. doi: 10.12659/msm.896344.
BACKGROUND Non-invasive procedures such as acoustic radiation force impulse imaging (ARFI) shear-wave elastography are currently used for the assessment of liver fibrosis. In the course of chronic hepatitis C, significant liver fibrosis or cirrhosis develops in approximately 25% of patients, which is a negative predictor of antiviral treatment response. Cirrhosis can be prevented by successful virus elimination. In this prospective study, a pretreatment ARFI cutoff value of 1.5 m/s was evaluated in relation to sustained virological response to anti-HCV therapy. MATERIAL AND METHODS In 23 patients with chronic hepatitis C, liver stiffness was examined with ARFI at defined times before and under antiviral triple therapy (peginterferon, ribavirin in combination with a first-generation protease inhibitor, and telaprevir or boceprevir). Patients were stratified into 2 groups based on pretreatment ARFI values (<1.5 m/s and ≥1.5 m/s) for the assessment of virological response. RESULTS The liver stiffness at baseline for all patients was 1.57±0.79 m/s (ARFI median ± standard deviation; margin: 0.81 m/s to 3.45 m/s). At week 4 of triple therapy, patients with low pretreatment ARFI values had higher rates of HCV-RNA negativity (69% vs. 43%), reflecting an early rapid virological response (eRVR). Sustained virological response (SVR) was found in 75% (12/16) of patients with an ARFI value <1.5 m/s and only 57% (4/7) of patients with ARFI value ≥1.5 m/s. CONCLUSIONS Patients with chronic hepatitis C and pretreatment ARFI <1.5 m/s showed earlier virus elimination and better response to treatment.
背景 诸如声辐射力脉冲成像（ARFI）剪切波弹性成像等非侵入性检查目前用于评估肝纤维化。在慢性丙型肝炎病程中，约25%的患者会发展为显著肝纤维化或肝硬化，这是抗病毒治疗反应的阴性预测指标。成功清除病毒可预防肝硬化。在这项前瞻性研究中，评估了预处理ARFI临界值1.5米/秒与抗丙肝病毒治疗的持续病毒学应答之间的关系。材料与方法 对23例慢性丙型肝炎患者在抗病毒三联疗法（聚乙二醇干扰素、利巴韦林联合第一代蛋白酶抑制剂以及特拉匹韦或博赛匹韦）之前及治疗期间的特定时间点用ARFI检查肝脏硬度。根据预处理ARFI值（<1.5米/秒和≥1.5米/秒）将患者分为两组以评估病毒学应答。结果 所有患者基线时的肝脏硬度为1.57±0.79米/秒（ARFI中位数±标准差；范围：0.81米/秒至3.45米/秒）。在三联疗法第4周时，预处理ARFI值低的患者丙肝病毒RNA阴性率更高（69%对43%），反映出早期快速病毒学应答（eRVR）。ARFI值<1.5米/秒的患者中75%（12/16）获得持续病毒学应答（SVR），而ARFI值≥1.5米/秒的患者中只有57%（4/7）获得SVR。结论 慢性丙型肝炎且预处理ARFI<1.5米/秒的患者病毒清除更早且治疗反应更好。
