Ye Junzhao, Huang Yang, Sun Yanhong, Shao Congxiang, Zhang Shenghong, Wang Wei, Zhong Bihui
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2021 Nov;9(21):1613. doi: 10.21037/atm-21-3142.
Two-dimensional shear wave elastography (2D-SWE) can be used to accurately assess significant liver fibrosis in chronic hepatitis B (CHB). However, whether those with decompensated cirrhosis could benefit from surveillance with 2D-SWE remains unclear. We aimed to evaluate the association between dynamic changes in 2D-SWE measurements and the prognosis of CHB-related decompensated cirrhosis.
We prospectively enrolled 149 consecutive treatment-naive CHB patients with decompensated cirrhosis from a clinical trial (registration number: ChiCTR-DCD-15006000) from February 2015 to December 2018. 2D-SWE was performed at 48-week intervals until December 2020. Liver-related events (LREs) were recorded through electronic medical records and telephone interviews.
The liver stiffness measurement (LSM) levels persistently reduced after antiviral therapy in patients who did not develop LREs, while patients with LREs showed a fluctuating trend of LSM alterations. Low pre-treatment 2D-SWE LSM, ∆% 2D-SWE LSM pre-virus control, and ∆% 2D-SWE LSM pre-post treatment were characterized by similar prognostic abilities as high levels of these parameters. Post-treatment 2D-SWE LSM was independently correlated with LREs in multivariate Cox regression models after antiviral treatments [hazard ratio (HR) =1.05; 95% confidence interval (CI): 1.02-1.08, P=0.0007 and 1.11; 95% CI: 1.04-1.18, P=0.0026]. Receiver operating characteristic (ROC) curve analysis identified that post-treatment 2D-SWE LSM exhibited the best predictive power for LREs among all the other variables, including parameters of 2D-SWE and serum fibrosis markers (area under the curve =0.75, P<0.001).
The last follow-up LSM, rather than pre-treatment or dynamic changes in 2D-SWE serves as a powerful predictor of LREs, suggesting that sequential monitoring may be beneficial to predicting prognosis.
二维剪切波弹性成像（2D-SWE）可用于准确评估慢性乙型肝炎（CHB）患者的显著肝纤维化。然而，失代偿期肝硬化患者能否从2D-SWE监测中获益仍不清楚。我们旨在评估2D-SWE测量的动态变化与CHB相关失代偿期肝硬化预后之间的关联。
我们前瞻性地纳入了149例来自一项临床试验（注册号：ChiCTR-DCD-15006000）的未经治疗的CHB失代偿期肝硬化患者，时间跨度为2015年2月至2018年12月。每48周进行一次2D-SWE检查，直至2020年12月。通过电子病历和电话访谈记录肝脏相关事件（LREs）。
未发生LREs的患者在抗病毒治疗后肝脏硬度测量（LSM）水平持续降低，而发生LREs的患者LSM变化呈波动趋势。治疗前2D-SWE LSM水平低、病毒控制前2D-SWE LSM的变化百分比（∆%）以及治疗前后2D-SWE LSM的变化百分比（∆%）与这些参数的高水平具有相似的预后评估能力。在抗病毒治疗后的多变量Cox回归模型中，治疗后2D-SWE LSM与LREs独立相关[风险比（HR）=1.05；95%置信区间（CI）：1.02-1.08，P=0.0007；以及HR =1.11；95% CI：1.04-1.18，P=0.0026]。受试者工作特征（ROC）曲线分析表明，在所有其他变量中，包括2D-SWE参数和血清纤维化标志物，治疗后2D-SWE LSM对LREs的预测能力最佳（曲线下面积=0.75，P<0.001）。
末次随访的LSM，而非治疗前或2D-SWE的动态变化，是LREs的有力预测指标，这表明连续监测可能有助于预测预后。
