Chang Ruei-Hsin, Nyamsuren Tsolmon, Gyawali Sarvesh, Fu Szu-Chieh, Huang Yi-Wen, Hu Rui-Ting, Yang Sien-Sing
Liver Center, Cathay General Hospital Medical Center, Taipei, Taiwan.
Chingeltei District Health Unit, Ulaanbaatar, Mongolia.
J Med Ultrasound. 2017 Jul-Sep;25(3):161-166. doi: 10.1016/j.jmu.2017.03.013. Epub 2017 May 6.
Histological improvement and regression of liver fibrosis after long-term use of nucleos(t)ides analogues (NUCs) have been documented. The aim of the present investigation was to evaluate the usefulness of traditional sonography to detect hepatic and splenic changes during NUC therapy in chronic hepatitis B (CHB) patients.
A total of 181 CHB patients receiving NUC treatment were enrolled in this study. The study population was divided into three groups 72 cirrhotic, 58 noncirrhotic CHB, and 51 nonreplicative hepatitis B virus carriers. All patients had blood chemistries taken and sonography at baseline and during the NUC treatment period. The changes in liver size, liver edge, spleen size, platelet count, and platelet count/spleen diameter (PC/SD) ratio were compared among the three groups of patients.
CHB Patients with and without cirrhosis have improved clinical features during NUC therapy with lower aspartate aminotransferase, alanine aminotransferase, international normalized ratio, hepatitis B virus DNA, and spleen size and higher platelet, liver edge, liver size, and PC/SD ratio compared with the baseline data ( < 0.05). The differences in liver edge, liver size, spleen size, and PC/SD ratio are higher in the cirrhosis group than in the non-cirrhotic group ( < 0.001). A decrease in spleen size exhibited a linear relationship with treatment duration ( = 0.905).
Traditional sonography is helpful to monitor changes in liver fibrosis of CHB patients under NUC therapy. AFP, α-fetoprotein; ALT, alanine transaminase; AST, aspartate transaminase; CHB, chronic hepatitis B; Hb, hemoglobin; HBV, hepatitis B virus; INR, international normalized ratio; NUCs, nucleos(t)ides analogues; PC/SD, platelet count/spleen diameter; WBC, white blood cells.
长期使用核苷（酸）类似物（NUCs）后肝纤维化的组织学改善和消退已有文献记载。本研究的目的是评估传统超声检查在慢性乙型肝炎（CHB）患者接受NUC治疗期间检测肝脏和脾脏变化的实用性。
本研究共纳入181例接受NUC治疗的CHB患者。研究人群分为三组：72例肝硬化患者、58例非肝硬化CHB患者和51例非复制型乙型肝炎病毒携带者。所有患者在基线时以及NUC治疗期间均进行了血液化学检查和超声检查。比较了三组患者肝脏大小、肝边缘、脾脏大小、血小板计数以及血小板计数/脾脏直径（PC/SD）比值的变化。
与基线数据相比，接受和未接受肝硬化治疗的CHB患者在NUC治疗期间临床特征有所改善，天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、国际标准化比值、乙型肝炎病毒DNA和脾脏大小降低，血小板、肝边缘、肝脏大小和PC/SD比值升高（<0.05）。肝硬化组肝边缘、肝脏大小、脾脏大小和PC/SD比值的差异高于非肝硬化组（<0.001）。脾脏大小的减小与治疗持续时间呈线性关系（=0.905）。
传统超声检查有助于监测CHB患者在NUC治疗下肝纤维化的变化。AFP，甲胎蛋白；ALT，丙氨酸转氨酶；AST，天门冬氨酸氨基转移酶；CHB，慢性乙型肝炎；Hb，血红蛋白；HBV，乙型肝炎病毒；INR，国际标准化比值；NUCs，核苷（酸）类似物；PC/SD，血小板计数/脾脏直径；WBC，白细胞。
