Li Mingwei, Yao Mingjie, Wang Leijie, Liu Yanna, Ji Dong, Yang Yongping, Lu Fengmin
Research Center for Clinical Medical Sciences, the Fourth Hospital of Shijiazhuang, Shijiazhuang, China.
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China.
J Clin Gastroenterol. 2025;59(5):456-463. doi: 10.1097/MCG.0000000000002032. Epub 2024 Jul 11.
Hepatic inflammation, the driver of fibrosis progression in liver disease, can impact the accuracy of liver stiffness measurement (LSM). We wondered whether the decline in LSM value during the early antiviral phase was mainly attributed to the control of hepatic inflammation or the regression of fibrosis in patients with fibrotic/cirrhotic chronic hepatitis B (CHB).
The study cohort was composed of 82 patients with CHB who underwent antiviral and antifibrotic therapy at the Fifth Medical Center of PLA General Hospital. All patients had liver biopsies at both baseline and 72 weeks posttherapy. Liver pathology and clinical data, including the LSM value, were collected.
After 72 weeks of treatment, both the histologic activity index score and fibrosis score, as well as the LSM value, were significantly decreased ( P < 0.001), compared with their baseline values. The pretreatment correlation of LSM value with either histologic activity index score ( r = 0.526 vs r = 0.286) or fibrosis score ( r = 0.677 vs r = 0.587) was attenuated at 72 weeks. Notably, logistic regression analysis revealed that the improvement in inflammation (odds ratio = 1.018, 95% CI: 1.002-1.031, P = 0.023) but not fibrosis (odds ratio = 0.994, 95% CI: 0.980-1.009, P = 0.414), had an impact on the change in LSM values between baseline and at 72-week treatment.
The findings of this study suggest that in patients with fibrotic CHB receiving antiviral medication, the early phase reduction in LSM value was related to improved hepatic inflammation rather than fibrosis regression.
肝脏炎症是肝病纤维化进展的驱动因素，可影响肝脏硬度测量（LSM）的准确性。我们想知道，在纤维化/肝硬化慢性乙型肝炎（CHB）患者的抗病毒治疗早期阶段，LSM值的下降主要是归因于肝脏炎症的控制还是纤维化的消退。
研究队列由82例在解放军总医院第五医学中心接受抗病毒和抗纤维化治疗的CHB患者组成。所有患者在基线和治疗后72周均接受了肝脏活检。收集肝脏病理和临床数据，包括LSM值。
治疗72周后，组织学活动指数评分、纤维化评分以及LSM值均较基线值显著降低（P<0.001）。LSM值与组织学活动指数评分（r=0.526 vs r=0.286）或纤维化评分（r=0.677 vs r=0.587）的预处理相关性在72周时减弱。值得注意的是，逻辑回归分析显示，炎症的改善（比值比=1.018，95%CI：1.002-1.031，P=0.023）而非纤维化的改善（比值比=0.994，95%CI：0.980-1.009，P=0.414），对基线和治疗72周时LSM值的变化有影响。
本研究结果表明，在接受抗病毒药物治疗的纤维化CHB患者中，LSM值在早期阶段的降低与肝脏炎症改善有关，而非纤维化消退。
