瞬时弹性成像检测在慢性丙型肝炎抗病毒治疗疗效评估中的应用

发布时间：2018-10-24 12:03

【摘要】：目的:本研究旨在探讨聚乙二醇干扰素联合利巴韦林(二联疗法)治疗对于慢性丙型肝炎患者肝硬度值的影响,以及对于上述抗病毒治疗方案疗效不同的患者肝硬度值变化有何差异。方法:采用回顾性分析研究,收集2014年4月至2015年12月期间来吉林大学第二医院肝胆胰内科住院的慢性丙型肝炎患者84例,其中男38例,女46例,平均年龄58.3±11.2岁,上述病人均根据基因型给予24周或48周聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗。治疗中随访,根据患者对于抗病毒应答的效果,分为获得SVR组,未获得SVR组(包括无应答及复发),同时收集所有患者治疗前和治疗结束时的肝硬度值、BMI、肝功能指标(ALT、AST)及患者长期随访结束时的肝硬度值,比较治疗前与治疗结束时及治疗结束时与长期随访结束时肝硬度值及相关指标的改善情况。结果:1.抗病毒治疗对肝硬度值及肝硬度分期的影响治疗结束时,获得SVR组及未获得SVR组两组肝硬度值较治疗前均明显降低,组内比较均有统计学差异(P0.05);获得SVR组、未获得SVR组组间比较无统计学差异(P0.05)。在获得SVR组内,男性、女性治疗前和治疗结束时肝硬度值比较,女性较男性肝硬度值下降更明显,两者比较有统计学差异(P0.05)。获得SVR组内治疗前分期为F4期患者治疗结束时肝硬度值较治疗前下降约为治疗前分期为非F4期患者的5倍,两者比较有显著统计学差异(P0.01);治疗前分期为F4的31例患者中仍有10例患者治疗结束时仍为F4期;63例治疗前为非F0-F1期的患者,治疗结束时仅有27例患者肝硬度值降低到F0-F1期。2.抗病毒治疗对BMI及肝功能指标的影响治疗结束时与治疗前比较,BMI值无论对于抗病毒效果有效还是无效的患者均有轻微升高,获得SVR组及未获得SVR组治疗前与治疗结束时BMI比较均有显著统计学差异(P0.05)。治疗结束时两组肝功能指标(ALT、AST治疗后仍异常患者共4例,其中3例为未获得SVR组患者)基本恢复正常,各指标治疗前后降低幅度(均值)组间比较,无明显差异(P0.05);肝硬度值与ALT、AST、BMI的Pearson相关分析表明,弹性值与ALT、AST、BMI存在显著相关性(P0.01)。3.患者长期随访肝硬度值变化在所有获得SVR的患者中,最后一次随访的肝硬度值较治疗结束时肝硬度值有轻度下降,两者比较有统计学差异(P0.05)。未获得SVR组最后一次随访的肝硬度值较治疗结束时肝硬度值有轻度升高,两者比较有统计学差异(P0.05)。在74例获得SVR的患者中,治疗前分期为F4的31例患者中仍有10例患者治疗结束时仍为F4期,其中2例患者最后一次随访时肝硬度值降至F3期。结论:肝脏瞬时弹性成像检测结果在抗病毒治疗的患者中无论抗病毒应答疗效如何均明显改善;但在治疗结束后长期随访,获得SVR组患者的肝硬度值持续下降,未获得SVR组患者的肝硬度值进行性升高;有效抗病毒治疗可能使肝纤维化甚至肝硬化部分逆转,但并不能使肝脏损害完全根除,在发生持续肝损害前及早确诊并进行抗病毒治疗非常必要。
[Abstract]:Objective: The aim of this study was to investigate the effect of polyethylene glycol interferon (PEG) on liver hardness in patients with chronic hepatitis C and the difference in the changes of liver hardness in patients with different efficacy. Methods: 84 patients with chronic hepatitis C were collected from April 2014 to December 2015. Among them, 38 males and 46 females, with an average age of 58. 3 and 11. 2 years old. All of the above mentioned patients were given a 24-week or 48-week polyethylene glycol interferon gamma-2a combined with anti-virus treatment according to the genotype. Follow-up in the treatment, according to the effect of the patient on the antiviral response, was divided into the right to obtain the SVR group, without the SVR group (including cirrhosis and recurrence), while collecting the liver hardness values, BMI, liver function indexes (ALT) at the end of treatment and at the end of treatment for all patients, AST) and liver hardness value at the end of long-term follow-up of the patient, compare the improvement of liver hardness value and related index at the end of treatment and at the end of treatment and at the end of long-term follow-up. Result: 1. At the end of the treatment of the effect of antiviral therapy on the liver hardness value and the liver hardness stage, the liver hardness values of both groups were significantly lower than those in the group without SVR group (P <0.05), and there was no statistical difference in the group (P0.05). There was a statistically significant difference between male and female patients before and after treatment (P <0.05). At the end of treatment, the level of liver hardness decreased about 5 times before treatment, and there was significant difference between the two groups (P <0.01). Of the 31 patients with F4 before treatment, there were still 10 patients with F4 phase at the end of treatment; 63 patients who were non F0-F1 prior to treatment, only 27 patients had liver hardness decreased to F0-F1 phase at the end of treatment. At the end of the treatment with anti-viral therapy on BMI and liver function index, the BMI value was slightly higher regardless of whether the anti-viral effect was effective or invalid, and there was a significant difference in BMI between the SVR group and the patients without SVR group before and after treatment (P0.05). There were 4 patients with abnormal liver function indexes (ALT and AST after treatment) at the end of the treatment, of which 3 were patients who did not get the SVR group (n = 3), and there was no significant difference between the two groups (P <0.05); the liver hardness values were compared with ALT and AST. Pearson correlation analysis of BMI showed that the elastic values were significantly correlated with ALT, AST and BMI (P0.01). During the long-term follow-up of patients with SVR, the liver hardness value of the last follow-up was slightly lower than that at the end of the treatment (P0.05). There was a slight increase in the liver hardness value at the end of the treatment without the last follow-up of the SVR group (P0.05). Of the 74 patients with SVR, 10 of the 31 patients with pre-treatment stage F4 remained at the end of treatment at the end of treatment, of which 2 patients had a final follow-up of the liver hardness to F3. Conclusion: The results of transient elastography in liver were significantly improved in patients with antiviral therapy, regardless of the efficacy of anti-viral responses; however, after long-term follow-up after the end of the treatment, the level of liver hardness in patients with SVR was continuously decreased, and the level of liver hardness in patients with SVR was not increased. Effective antiviral therapy may reverse liver fibrosis and even cirrhosis, but it is not possible to completely eradicate liver damage, and it is necessary to diagnose and perform antiviral therapy early before the occurrence of persistent liver damage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.63

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