Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
Department of Epidemiology, University of Valle, Cali, Colombia.
Dig Liver Dis. 2018 Aug;50(8):787-794. doi: 10.1016/j.dld.2018.05.005. Epub 2018 May 15.
Time-varying impact of anti-viral therapy on liver stiffness in patients with hepatitis B is unclear.
To estimate the magnitude and kinetics of change in liver stiffness in hepatitis B patients treated with nucleot(s)ide analogs.
Through a systematic review of multiple databases, we identified 24 studies in adults with hepatitis B who underwent transient elastography before and at least 6 months after starting nucleot(s)ide analogs therapy. We estimated change in liver stiffness 6 m, 12 m, 24 m, 36 m and 60 m after starting therapy, as weighted mean difference and 95% confidence intervals, using random-effects meta-analysis.
Liver stiffness significantly declined by 2.21 kPa (95% CI, -1.36 to -3.05), 2.56 kPa (-2.23 to -2.89), 3.73 kPa (-2.98 to -4.49), 4.15 kPa (-2.75 to -5.54), and 5.19 kPa (-3.34 to -7.03) at 6 months, 1 year, 2 years, 3 years, and 5 years from the start of therapy, respectively (p < 0.001). High baseline alanine aminotransferase level, viral load and liver stiffness were associated with greater magnitude of decline in liver stiffness.
Antiviral therapy is associated with progressive decline in liver stiffness in patients with hepatitis B, particularly in patients with high baseline alanine aminotransferase and viral load.
抗病毒治疗对乙型肝炎患者肝硬度的时变影响尚不清楚。
评估核苷（酸）类似物治疗的乙型肝炎患者肝硬度的变化幅度和动力学。
通过对多个数据库进行系统回顾，我们确定了 24 项在开始核苷（酸）类似物治疗前和至少 6 个月后接受瞬时弹性成像的成年乙型肝炎患者的研究。我们使用随机效应荟萃分析，估计治疗开始后 6、12、24、36 和 60 个月时肝硬度的变化，结果表示为加权均数差和 95%置信区间。
肝硬度分别显著下降 2.21 kPa（95%CI，-1.36 至-3.05）、2.56 kPa（-2.23 至-2.89）、3.73 kPa（-2.98 至-4.49）、4.15 kPa（-2.75 至-5.54）和 5.19 kPa（-3.34 至-7.03），分别在治疗开始后 6 个月、1 年、2 年、3 年和 5 年（p<0.001）。高基线丙氨酸氨基转移酶水平、病毒载量和肝硬度与肝硬度下降幅度较大相关。
抗病毒治疗与乙型肝炎患者肝硬度的逐渐下降相关，尤其是在基线丙氨酸氨基转移酶和病毒载量较高的患者中。
