CAJ | 학술논문

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 DNA<40 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 log10 IU/ml以上），其肝脏硬度值、ALT和TBIL均显著高于基线水平（P<0.01）。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。
목적：평개순시탄성소묘（FibroScan）동태감측은체잡위（ETV）치료만성을형간염（chronic hepatitis B, CHB）간경화과정중간섬유화개선적작용。방법선택아원수치적CHB간경화환자352례，소유환자균접수ETV（초치환자혹아덕복위지내약환자0.5 mg/d，랍미부정내약환자1.0 mg/d）항병독치료。진행정기수방，수방시간불단우3년。매3~6개월진행간장경도측량（FibroScan）급생화학、병독학지표검측，관찰림상료효。결과경과지소3년적항병독치료，87.8%（309/352）적환자획득병독학응답（HBV DNA<40 IU/ml），기선급치료3년시간장경도치분별위30.8（17.3，46.4）kPa화18.6（12.0，27.9）kPa，차이유통계학의의（P=0.000）。9.7%（34/352）적환자유우각충원인발생병독학돌파（HBV DNA고우치료과정중최저점1 log10 IU/ml이상），기간장경도치、ALT화TBIL균현저고우기선수평（P<0.01）。결론 FibroScan재CHB간경화환자장기항병독과정중가동태감측간섬유화적변화，FibroScan검측가작위간장활체조직검사가고적체대방법。
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.