Non-invasive Assessment of Changes in Liver Fibrosis via Liver Stiffness Measurement in Patients

Seung Up Kim1, Jun Yong Park1, Do Young Kim1, Sang Hoon Ahn1, Eun Hee Choi2, Jae Yeon Seok3, Jung Min Lee1, Young Nyun Park3, Chae Yoon Chon1, Young Myoung Moon4, Kwang Hyub Han1

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

2Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea

3Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

4Department of Internal Medicine, Kwandong University College of Medicine, Goyang, Korea

OBJECTIVES: Liver stiffness measurement (LSM) assesses liver fibrosis accurately in patients with chronic hepatitis B (CHB). This study evaluated whether LSM, rather than invasive liver biopsy (LB), can be used to assess changes in liver fibrosis during antiviral treatment using nucleos(t)ide analogues in patients with CHB.

METHODS: We recruited 41 patients with CHB who had significant liver fibrosis or necroinflammation on LB, normal or slightly elevated serum alanine aminotransferase (ALT) levels (<=2x upper limit of normal), and detectable serum hepatitis B virus (HBV) DNA before antiviral treatment. The patients underwent LSM at the time of LB. Patients in Group 1 (n=23) and Group 2 (n=18) underwent follow-up LSM after antiviral treatment for 1 and 2 years, respectively.

RESULTS: The mean age, ALT level, and LSM value of all patients (34 men and 7 women) before antiviral treatment were 46.6 ± 9.5 years, 40.6 ± 17.2 IU/L, and 12.9 ± 8.6 kPa, respectively. Hepatitis B e antigen (HBeAg) was detected in 31 patients (75.6%). According to the METAVIR scoring system, the fibrosis stage was F1 in two (4.9%), F2 in 12 (29.3%), F3 in four (9.8%), and F4 in 23 (56.1%) patients, and the activity grade was A2 in 26 (63.4%) and A3 in 15 (36.6%) patients. After antiviral treatment, LSM values and DNA positivity decreased significantly compared to baseline in both groups (P=0.018 and P<0.001 in Group 1; P=0.017 and P<0.001 in Group 2, respectively), whereas ALT levels were unchanged (P=0.063 in Group 1, P=0.082 in Group 2). Non-invasive models, such as the age-platelet index (API) and aspartate aminotransferase (AST) to platelet ratio index (APRI) also failed to predict liver fibrosis regression.

CONCLUSIONS: Our preliminary data suggest that LSM can be used to assess liver fibrosis regression after antiviral treatment using nucleos(t)ide analogues in patients with CHB.