الفهرس 
Chronic hepatitis BOnly 14 pages are availabe for public view
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Abstract
HBV infection is a serious public health problem and is the most important risk factor of liver cirrhosis and HCC in HBV endemic areas (Jian-Hua et al., 2011). Until, liver fibrosis and cirrhosis were generally considered to be irreversible (Bonis et al., 2000). However, several studies using serial LBs have reported that several therapeutic interventions can produce histological improvement, including liver fibrosis regression (Hammel et al., 2000; Shiratori et al., 2000 and Poynard et al., 2002). Among these therapeutic interventions, NAs that suppress HBV replication eliminated HBV DNA in 98% of cases and were significantly associated with liver fibrosis regression by reducing liver inflammation and cellular damage (EASL guidelines, 2017). Because the prognosis and management of patients with CHB, as well as other CLDs, depend strongly on the degree of liver fibrosis, the assessment of liver fibrosis regression is helpful to clinicians (Wright, 2006). However, follow-up LB for confirming liver fibrosis regression during or after antiviral treatment is troublesome except consenting subjects. Therefore, a noninvasive method to assess liver fibrosis regression in patients with CHB who have undergone antiviral treatment would be highly useful (Kim et al., 2010). Hence the main objective of this study was to evaluate the change in hepatic fibrosis through LSM using fibroscan in relation to antiviral therapy in patients with hepatitis B related chronic liver disease.
Summary and conclusion
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This study was conducted at Hepatology department, National Liver Institute. After an informed consent, 219 patients with hepatitis B related CLD were enrolled in the study. Two of them died before follow up and the remaining 217 completed their follow up till the end of the study. All patients underwent through history taking, complete physical examination, body weight, height, liver function tests, renal function tests, CBC and serum HBV DNA level by real time PCR every 6 months during the follow up period. LSM was done by TE twice for every patient with hepatitis B related CLD who was attended HBV clinic whether on treatment or initiating antiviral therapy at the time of inclusion in the study, at least six months elapsed before 2nd elastography examination, third examination was done for some cases, the two readings considered are those separated by the longest follow up duration. The change and percentage change of liver stiffeness values / month were calculated. Results were: • The mean values of the baseline and follow up LSM were 9.59± 7.45 and 8.20+7.05 kilopascal (kPa) with statistically significant decrease in the follow up LS values (p<0.001). • Fibrosis regression was higher in patients with advanced fibrosis (> F2) than in patients with minimal or no fibrosis (F0, F1) (p<0.001). • A significant decline in LS values (P=0.002) was achieved in treatment naive patients (0.27± 0.5 kPa/month) than in those who were on treatment (-0.08 ± 0.27 kPa/month). The percentage of decline of LS value/ month was significantly higher in treatment
Summary and conclusion
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naive patients (-18.84+20.37 kPa/month) than in those who were on treatment (-8.88+21.98 kPa/month) (P=0.002). • Regarding stage of fibrosis detected by TE in our study. We found that eighty eight patients (40.6%) showed improvement in fibrosis stage by LSM (≥ 1 decrease in fibrosis stage), 115 (52.9%) showed stationary stage of fibrosis, while 14 patients (6.5%) showed increase in fibrosis stage by ≥ 1 fibrosis stage. • The change in LSM / month were -0.02± 0.1, -0.07± 0.10, -0.12±0.21, -0.26±0.27 and -0.59±0.8 kPa/month in F0, F1, F2, F3 and F4 respectively. Patients with fibrosis stage (F4) demonstrated the highest monthly decline in LS value during antiviral therapy (p< 0.001). • A significant correlation was observed between the line of treatment and change of LSM / month. The mean values of change in LSM/ month were -0.28±0.54, -0.1±0.28, 0.13±0.22, -0.23±0.14, -0.06±0.08 kPa/month with TDF, LAM, ETV (one mg), ETV (half mg) and LAM plus ADV respectively. LSM significantly decreased in patients who received TDF (-0.28±0.54 kPa/month) versus those received LAM (-0.1±0.28 kPa/month) (p=0.01). • No statistical significant difference between the initial and follow up LSM as regarding the presence or absence of the viral resistance to treatment or HBe Ag status (P>0.05). • In conclusion, our data showed that antiviral treatment in patients with CHB was associated with decrease in LSM values and suggest that LSM might be used to assess the change in liver fibrosis after antiviral treatment using NAs in patients with CHB.