Histological regression and clinical benefits in patients with liver cirrhosis after long-term anti-HBV treatment
10.3760/cma.j.cn501113-20220508-00246
- VernacularTitle:长期抗病毒治疗乙型肝炎肝硬化患者的组织学逆转率和临床改善情况
- Author:
Shuyan CHEN
1
;
Yameng SUN
;
Jialing ZHOU
;
Xiaoning WU
;
Tongtong MENG
;
Bingqiong WANG
;
Hui LIU
;
Tailing WANG
;
Chen SHAO
;
Xinyu ZHAO
;
Xiaoqian XU
;
Yuanyuan KONG
;
Xiaojuan OU
;
Jidong JIA
;
Hong YOU
Author Information
1. 首都医科大学附属北京友谊医院肝病中心 国家消化系统疾病临床医学研究中心，北京 100050
- Keywords:
Hepatitis B;
Liver cirrhosis;
Regression;
Clinical benefit
- From:
Chinese Journal of Hepatology
2022;30(6):583-590
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Our study aims to determine histological regression and clinical improvement after long-term antiviral therapy in hepatitis B virus-related cirrhosis patients.Methods:Treatment-na?ve chronic hepatitis B patients with histologically or clinically diagnosed liver cirrhosis were enrolled. Liver biopsies were performed after 5 years entecavir-based antiviral treatment. Patients were followed up every 6 months. Cirrhosis regression was evaluated based on Metavir system and P-I-R score. Clinical improvement was evaluated before and after the long-term treatment. Kruskal Wallis test and Wilcoxon signed-rank test were used for continuous variables, Fisher's exact test was used for categorical variables and multivariate analysis was performed using logistic regression analysis.Results:Totals of 73 patients with HBV-related liver cirrhosis were enrolled. Among them, 30 (41.1%) patients were biopsy proved liver cirrhosis and the remaining 43 (58.9%) cirrhotic patients were diagnosed by clinical features. Based on Metavir system and P-I-R score, 72.6% (53/73) patients attained histological regression. Furthermore, 30.1% (22/73) were defined as significant regression (Metavir decrease ≥2 stage), 42.5% (31/73) were mild regression (Metavir decrease 1 stage or predominantly regressive by P-I-R system if still cirrhosis after treatment) and 27.4% (20/73) were the non-regression. Compared to levels of clinical characteristics at baseline, HBV DNA, ALT, AST, liver stiffness(decreased from 12.7 to 6.4 kPa in significant regression, from 18.1 to 7.3 kPa in mild regression and from 21.4 to 11.2 kPa in non-regression)and Ishak-HAI score significantly decreased after 5 years of anti-HBV treatment, while serum levels of platelets and albumin improved remarkably ( P<0.05). In multivariate analysis, only the pre-treatment liver stiffness level was associated with significant regression ( OR=0.887, 95% CI: 0.802-0.981, P=0.020). Conclusions:After long-term antiviral therapy, patients with HBV-related cirrhosis are easily to attain improvements in clinical parameters, while a certain percentage of these patients still cannot achieve histological reversal.
