FibroScan对恩替卡韦治疗慢性乙型肝炎肝硬化的疗效评价

目的评价瞬时弹性扫描(FibroScan)动态监测恩替卡韦(ETV)治疗慢性乙型肝炎(chronic hepatitis B,CHB)肝硬化过程中肝纤维化改善的作用。方法选择我院收治的CHB肝硬化患者352例,所有患者均接受ETV(初治患者或阿德福韦酯耐药患者0.5 mg/d,拉米夫定耐药患者1.0 mg/d)抗病毒治疗。进行定期随访,随访时间不短于3年。每3~6个月进行肝脏硬度测量(FibroScan)及生化学、病毒学指标检测,观察临床疗效。结果经过至少3年的抗病毒治疗,87.8%(309/352)的患者获得病毒学应答(HBV DNA40 IU/ml),基线及治疗3年时肝脏硬度值分别为30.8(17.3,46.4)kPa和18.6(12.0,27.9)kPa,差异有统计学意义(P=0.000)。9.7%(34/352)的患者由于各种原因发生病毒学突破(HBV DNA高于治疗过程中最低点1 log10IU/ml以上),其肝脏硬度值、ALT和TBIL均显著高于基线水平(P0.01)。结论 FibroScan在CHB肝硬化患者长期抗病毒过程中可动态监测肝纤维化的变化,FibroScan检测可作为肝脏活体组织检查可靠的替代方法。

Assessment of FibroScan on the therapeutic efficacy of entecavir treatment in cirrhotic patients with chronic hepatitis B

Objective To assess the usefulness of transient elastography （FibroScan） in dynamically monitoring the improve-ment of liver fibrosis in cirrhotic patients with chronic hepatitis B （CHB） receiving entecavir （ETV） treatment. Methods A total of 352 cirrhotic patients with CHB treated in our hospital were enrolled in the study. All the patients were administrated with ETV （0.5 mg/d for naive or adefovir dipivoxil-resistant patients, and 1.0 mg/d for lamivudine-resistant patients）. A follow-up was conducted over a 3-year period. Liver stiffness was measured by using FibroScan, and biochemical and virological examinations were conducted every 3-6 months, so that the clinical efficacy was observed. Results After 3-year ETV treatment, 87.8% （309/352） of the patients achieved virological response （defined as HBV DNA〈40 IU/ml）. The values of liver stiffness measurement at baseline and 3-year treatment were 30.8 （17.3, 46.4） kPa and 18.6 （12.0, 27.9） kPa, respectively, and the difference was significant （P=0.000）. Of 352 patients, 34 （9.7%） underwent virological breakthrough （defined as an increase of ≥1 log10 IU/ml in HBV DNA from nadir during the treatment） due to various reasons, and the values of liver stiffness measurement and the levels of ALT and TBIL were significantly higher than those at baseline （P〈0.01）. Conclusions FibroScan is useful for dynamically monitoring the changes in the severity of liver fibrosis in cirrhotic patients with CHB during antiviral treatment, and FibroScan examination can be considered as a credible al-ternative to liver biopsy.