Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B

Yameng Sun; Jialing Zhou; Lin Wang; Xiaoning WU; Yongpeng Chen; Hongxin Piao; Lungen LU; Wei Jiang; Youqing XU; Bo Feng; Yuemin Nan; Wen Xie; Guofeng Chen; Huanwei Zheng; Hai LI; Huiguo Ding; Hui Liu; Fudong Lyu; Chen Shao; Tailing Wang; Xiaojuan OU; Binqiong Wang; Shuyan Chen; Hong You; Jidong Jia

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Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B

VernacularTitle: 慢性乙型肝炎抗病毒治疗后肝纤维化逆转的病理定性评估
Author: Yameng SUN ¹ ; Jialing ZHOU ¹ ; Lin WANG ¹ ; Xiaoning WU ¹ ; Yongpeng CHEN ² ; Hongxin PIAO ³ ; Lungen LU ⁴ ; Wei JIANG ⁵ ; Youqing XU ⁶ ; Bo FENG ⁷ ; Yuemin NAN ⁸ ; Wen XIE ⁹ ; Guofeng CHEN ¹⁰ ; Huanwei ZHENG ¹¹ ; Hai LI ¹² ; Huiguo DING ¹³ ; Hui LIU ¹⁴ ; Fudong LYU ¹⁴ ; Chen SHAO ¹⁴ ; Tailing WANG ¹⁵ ; Xiaojuan OU ¹ ; Binqiong WANG ¹ ; Shuyan CHEN ¹ ; Hong YOU ¹ ; Jidong JIA ¹
Author Information

1. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
2. Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
3. Infectious Department, Affiliated Hospital of Yanbian University, Yanji 133000, China
4. Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
5. Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
6. Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
7. Hepatology Institute, Peking University People’s Hospital, Beijing 100044, China
8. Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
9. Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
10. Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Military Hospital of China, Beijing 100039, China
11. Department of Infectious Disease, the Fifth Hospital of Shijiazhuang City, Shijiazhuang 050024, China
12. Department of Hepatopancreatobiliary and Splenic Medicine, Affiliated Hospital, Logistics University of People’s Armed Police Force, Tianjin 300161, China
13. Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
14. Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
15. Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Publication Type:Journal Article
Keywords: Liver fibrosis; Anti-viral therapy; Qualitative histological assessment; Ishak score
From: Chinese Journal of Hepatology 2017;25(11):819-826
CountryChina
Language:Chinese
Abstract: Objective:To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.
Methods:Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.
Results:A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.
Conclusion:This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.