Liver stiffness becomes stable in patients with chronic hepatitis C three months after ALT normalization due to antiviral therapy
目的探讨ALT升高的慢性丙型肝炎(CHC)患者经抗病毒治疗ALT恢复正常后肝硬度达到稳定的时间。方法从2011年5月起筛查就诊于北京大学人民医院的CHC初治患者,其中ALT升高者纳入研究组,应用FibroScan检测肝硬度;至2012年9月基线入组患者29例,规律抗病毒治疗后定期随访:每4周复查ALT,每8周复查肝硬度,采用自身配对设计,两两比较前后相邻值的变化,直至ALT与肝硬度不再明显改变。前后配对比较采用非参数Wilcoxon检验,重复测量数据的多重比较采用Bonferoni矫正检验水准。两变量相关系数采用Spearman等级相关法。结果随访至抗病毒24周,纳入分析患者24例,ALT中位数在基线、4周、8周、12周、24周分别为64、26、21、20、22 U/L(前后两相邻值比较,P=0.000、0.006、0.337、0.109),即ALT于4周降至正常后继续下降,于8周后稳定;肝硬度中位数在基线、8、16、24周分别为8.7、7.8、6.8、6.7 kPa(前后两相邻值比较,P=0.009、0.001、0.188),即16周前持续下降,16周后未再明显下降。肝硬度于ALT恢...Abstract:
Objective To investigate the time for liver stiffness measurement ( LSM) to become stable in chronic hepatitis C ( CHC) patients with elevated alanine aminotransferase ( ALT) levels after ALT normalization due to antiviral therapy. Methods CHC patients who sought initial treatment at Peking University People's Hospital were screened for elevated ALT levels from May 2011. Liver stiffness was determined by FibroScan. A total of 29 patients had been included in the study by September 2012, who were followed up regularly after antiviral treatment. ALT tests were repeated every four weeks and LSM every eight weeks until their medians did not change significantly. Comparisons of matched data at two adjacent time points were made with the non- parametric Wilcoxon test, while multiple comparisons of repeated measurements were performed using Bonferroni correction. Correlation between two variables was analyzed with the Spearman rank test. Results Patients were followed up until 24 weeks after antiviral treatment, and 24 patients were included in analysis. The median ALT levels were 64, 26, 21, 20, and 22 U / L at baseline and 4, 8, 12, and 24 weeks, respectively ( P = 0. 000, 0. 006, 0. 337, and 0. 109 for comparisons between two adjacent values) . ALT decreased significantly below 1 ULN at 4 weeks after antiviral therapy and stabilized at 8 weeks.The median LSM values were 8. 7, 7. 8, 6. 8, and 6. 7 kPa at baseline and 8, 16, and 24 weeks, respectively ( P = 0. 009, 0. 001, and0. 188 for comparisons between two adjacent values) . LSM decreased significantly within 16 weeks after antiviral therapy and stabilized afterwards. LSM stabilized 12 weeks after ALT normalization. Conclusion LSM becomes stable in CHC patients with elevated ALT levels three months after ALT normalization due to antiviral therapy.
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