富马酸替诺福韦二吡呋酯（TDF）治疗慢性乙型肝炎（CHB）患者取得成功并不能保证通过瞬时弹性成像评估的肝损伤得到改善。一项回顾性-前瞻性多中心研究。

Successful therapy with tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) does not guarantee amelioration of liver damage assessing by transient elastography. A retrospective - prospective multicenter study.

机构信息

2nd Academic Department of Internal Medicine, Liver- GI Unit, General Hospital of Athens "Hippocration", National and Kapodistrian University of Athens, 114 Vas. Sofias str, 11527, Athens, Greece.

Department of Gastroenterology, University Hospital of Patras, Patra, Greece.

出版信息

BMC Gastroenterol. 2024 Apr 12;24(1):133. doi: 10.1186/s12876-024-03200-3.

DOI:10.1186/s12876-024-03200-3

PMID:38609880

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11010325/

Abstract

BACKGROUND

Preventing disease progression and viral suppression are the main goals of antiviral therapy in chronic hepatitis B (CHB). Liver stiffness measurement (LSM) by transient elastography is a reliable non-invasive method to assess liver fibrosis in patients with CHB. Our aim was to explore factors that may affect changes in LSMs during long term tenofovir (TDF) monotherapy in a well characterized cohort of patients with compensated CHB.

METHODS

We analyzed serial LSMs in 103 adult patients with CHB who were on TDF monotherapy and had at least three LSMs over a period of 90 months.

RESULTS

Twenty-five (24%) patients had advanced fibrosis at baseline. A significant decline in mean LSM between baseline and last visit (8.7 ± 6.2 kPa vs. 6.7 ± 3.3, p = 10) was observed. Twenty-four (23%) patients had progression of liver fibrosis with mean increase in liver stiffness of 2.8 kPa (range: 0.2-10.2 kPa). Multivariate analysis showed that BMI ≥ 25 (OR, 0.014; 95% CI, 0.001-0.157; p = 0.001) and advanced fibrosis (OR, 5.169; 95% CI, 1.240-21.540; p = 0.024) were independently associated with a fibrosis regression of > 30% of liver stiffness compared to baseline value.

CONCLUSIONS

In CHB patients TDF monotherapy resulted in liver fibrosis regression, especially in patients with advanced fibrosis. Despite the successful antiviral effect of TDF, 1 out of 4 patients had liver fibrosis progression. Obesity and advanced fibrosis at baseline were independently associated with significant liver fibrosis regression.

摘要

背景

预防疾病进展和病毒抑制是慢性乙型肝炎（CHB）抗病毒治疗的主要目标。瞬时弹性成像的肝硬度测量（LSM）是评估 CHB 患者肝纤维化的一种可靠的非侵入性方法。我们的目的是在经过充分特征描述的 CHB 患者队列中探索可能影响长期替诺福韦（TDF）单药治疗期间 LSM 变化的因素。

方法

我们分析了 103 例接受 TDF 单药治疗且在 90 个月期间至少有 3 次 LSM 的 CHB 成年患者的系列 LSM。

结果

基线时有 25 例（24%）患者存在晚期纤维化。与基线相比，最后一次就诊时 LSM 平均值显著下降（8.7±6.2kPa 比 6.7±3.3kPa，p=10）。24 例（23%）患者的肝纤维化进展，肝硬度平均增加 2.8kPa（范围：0.2-10.2kPa）。多变量分析显示，BMI≥25（比值比，0.014；95%可信区间，0.001-0.157；p=0.001）和晚期纤维化（比值比，5.169；95%可信区间，1.240-21.540；p=0.024）与基线值相比，肝硬度下降>30%与纤维化消退独立相关。