Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Infectious Department, Affiliated Hospital of Yanbian University, Yanji, China.
Liver Int. 2018 Jun;38(6):1045-1054. doi: 10.1111/liv.13623. Epub 2017 Nov 29.
BACKGROUND & AIMS: It is unclear whether liver stiffness measurement (LSM) dynamic changes after anti-HBV treatment could predict the risk of liver-related events (LREs), particularly in patients with HBV-related compensated cirrhosis.
Treatment-naïve patients with HBV-related compensated cirrhosis were enrolled. All patients were under entecavir-based antiviral therapy, and followed up every 26 weeks for 2 years. The association between LSM and LREs was analysed by Cox proportional hazard model and Harrell C-index analysis.
A total of 438 patients were included in the study. At the follow-up of 104 weeks, LREs developed in 33/438 (7.8%) patients, including 16 episodes of decompensation, 18 HCC and 3 deaths. The median LSM remained high from 20.9, 18.6, 20.4 to 20.3 Kpa at week 0, 26, 52 and 78 among patients with LREs, whereas the LSM decreased from 17.8, 12.3, 10.6 to 10.2 Kpa in patients without LREs respectively. Percentage changes of LSM at 26 weeks from baseline were significantly associated with LREs (excluding 11 cases occurred within the first 26 weeks), with a crude hazard ratio of 2.94 (95% CI: 1.73-5.00) and an albumin-adjusted hazard ratio of 2.47 (95% CI: 1.49-4.11). The Harrell C-index of these 2 models for predicting 2-year LREs were 0.68 (95% CI: 0.56-0.80) and 0.75 (95% CI: 0.65-0.85) respectively. Nomograms were developed to identify individuals at high risk for point-of-care application.
Dynamic changes of LSM alone, or combined with baseline albumin, could predict LREs in patients with HBV-related compensated cirrhosis during antiviral therapy.
尚不清楚抗病毒治疗后肝硬度值（LSM）的动态变化是否能预测肝脏相关事件（LREs）的风险，尤其是在乙型肝炎病毒（HBV）相关代偿性肝硬化患者中。
纳入初治的 HBV 相关代偿性肝硬化患者。所有患者均接受恩替卡韦为基础的抗病毒治疗，并在 2 年内每 26 周随访一次。采用 Cox 比例风险模型和 Harrell C 指数分析 LSM 与 LREs 的相关性。
共纳入 438 例患者。在 104 周的随访中，33/438（7.8%）例患者发生 LREs，包括 16 例失代偿，18 例 HCC 和 3 例死亡。发生 LREs 的患者 LSM 中位数在第 0、26、52 和 78 周分别保持在 20.9、18.6、20.4 和 20.3kPa，而无 LREs 的患者 LSM 分别从 17.8、12.3、10.6 和 10.2kPa 降低。基线时 26 周 LSM 的百分比变化与 LREs 显著相关（排除前 26 周发生的 11 例），粗危险比为 2.94（95%CI：1.73-5.00），白蛋白校正后的危险比为 2.47（95%CI：1.49-4.11）。这两个模型预测 2 年 LREs 的 Harrell C 指数分别为 0.68（95%CI：0.56-0.80）和 0.75（95%CI：0.65-0.85）。建立了列线图来识别具有高风险的个体，以便在床边应用。
抗病毒治疗期间，LSM 的动态变化，或与基线白蛋白联合，可预测 HBV 相关代偿性肝硬化患者的 LREs。
