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血小板的增加与恩替卡韦治疗的显著纤维化慢性乙型肝炎患者肝纤维化改善相关。

Platelets' increase is associated with improvement of liver fibrosis in entecavir-treated chronic hepatitis B patients with significant liver fibrosis.

机构信息

Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.

出版信息

Hepatol Int. 2018 May;12(3):237-243. doi: 10.1007/s12072-018-9864-z. Epub 2018 Apr 26.

Abstract

BACKGROUND AND AIM

Reduction of platelet count is often observed in chronic hepatitis B (CHB) patients with significant liver fibrosis. In this cohort study, we investigated whether platelets' increase after entecavir (ETV) therapy was associated with the improvement of liver fibrosis.

METHODS

We collected the data of a cohort 82 CHB patients with paired liver biopsies before and after 78-week ETV therapy, and assessed the platelets' change following the treatment and further investigated the associated clinical factors with platelets' change.

RESULTS

Platelet count increased after treatment, which occurred mainly in patients with low baseline level of platelet count (< 200 × 10/L) or with significant fibrosis (Ishak ≥ 3). Regression analysis showed that baseline platelet count was the main factor associated with post-treatment increase of platelets (β = - 0.215, p = 0.015). In patients with significant fibrosis, correlation and linear regression analysis revealed that post-treatment platelets' increase was correlated with improvement of liver fibrosis assessed by reduction of quantitative collagen percentage area (r = 0.392, p = 0.006) (β = 2.449, p = 0.035), but no correlation between changes in platelet counts and Ishak fibrosis score. Receiver operating curve analysis showed an increase of 12.5 × 10/L in platelet count could identify improvement of liver fibrosis (AUC = 0.70).

CONCLUSION

Platelets' increase after ETV therapy was associated to the improvement of liver fibrosis with reduction of collagen percentage area in CHB patients with significant fibrosis.

摘要

背景与目的

乙型肝炎慢性患者(CHB)常伴有血小板计数减少,且纤维化程度越重,血小板计数越低。本研究旨在观察恩替卡韦(ETV)治疗后血小板计数的增加是否与肝纤维化的改善相关。

方法

回顾性分析 82 例接受 ETV 治疗 78 周的 CHB 患者的临床资料,比较治疗前后血小板计数的变化,并进一步分析血小板计数变化的相关临床因素。

结果

治疗后血小板计数增加,主要发生在基线血小板计数较低(<200×10/L)或纤维化程度较重(Ishak≥3)的患者中。回归分析显示,基线血小板计数是与治疗后血小板计数增加相关的主要因素(β=-0.215,p=0.015)。在纤维化程度较重的患者中,相关性及线性回归分析显示,治疗后血小板计数的增加与定量胶原百分比面积减少评估的肝纤维化改善相关(r=0.392,p=0.006)(β=2.449,p=0.035),但与 Ishak 纤维化评分的变化无相关性。受试者工作特征曲线分析显示,血小板计数增加 12.5×10/L 可识别肝纤维化的改善(AUC=0.70)。

结论

对于纤维化程度较重的 CHB 患者,ETV 治疗后血小板计数的增加与胶原百分比面积减少相关,提示肝纤维化的改善。

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