1. 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
Chinese Journal of Hepatology 2017;25(11):819-826
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 (
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