P-I-R分型和Laenn...毒治疗后组织学和预后的关系_吕采红.pdf

肝纤维化及肝硬化DOI:10 3969/j issn1001 5256 2023 03 015P I 分型和 Laennec 分级与乙型肝炎肝硬化患者抗病毒治疗后组织学和预后的关系吕采红1，2，宋铮1，2，罗婧1，3，常秀娟2，杨永平1，21 北京大学三二临床医学院，北京 100039;2 解放军总医院第五医学中心 肝病医学部，北京 100039;3 北京大学地坛医院教学医院 消化科，北京 100011通信作者:杨永平，yongpingyang hotmail com(OCID:0000 0002 8307 1095)摘要:目的研究 P I 分型和 Laennec 分级评价乙型肝炎肝硬化患者接受抗病毒治疗后的组织学改变，及两种评价系统与临床预后的关系。方法连续筛选 2013 年 10 月2014 年 10 月来自 14 个中心的 218 例患者，病理(Ishak评分5 分)诊断肝硬化接受抗病毒治疗 72 周完成 2 次肝组织活检，并符合 P I 分型标准。218 例患者分为无肝细胞癌(HCC)组(n=186)和 HCC 组(n=32)。计数资料组间比较采用 2检验和 Fisher 精确检验。比较抗病毒治疗后 HCC 发生情况时，连续变量采用非参数检验 Mann Whitney U 检验;比较 P I 分型与 Laennec 分级不同组间差异时，连续变量采用非参数检验 Kruskal Wallis H 检验。采用单因素和多因素 Cox 比例风险回归分析并计算风险比(H)和 95%CI。采用 Kaplan Meier 法计算 HCC 的累积发生率。结果抗病毒治疗 72 周后无 HCC 组和 HCC 组间P I 分型情况比较差异有统计学意义(P 0.001)。抗病毒治疗前后 Laennec 分级和 P I 分型的分布均有统计学差异(P 值均 0 001)。抗病毒治疗后，按照 Laennec 分级分为 4A 组(n=33)、4B 组(n=71)、4C 组(n=114)，3组间 PLT(H=36 429，P 0.001)、LSM(H=13 983，P=0 004)、Ishak 评分(2=23 060，P 0 001)、HAI 评分(P 0.001)比较差异均有统计学意义。抗病毒治疗 72 周后，按照 P I 分型分为 组(n=70)、I 组(n=52)和 P 组(n=96)，3 组间 PLT(H=7.193，P=0 028)、LSM(H=6 238，P=0 045)、Ishak 评分(2=7 986，P 0 001)、HAI 评分(P=0 002)、HCC 发生情况(P 0 001)比较，差异均有统计学意义。P I 分型 P 组和 组 HCC 发生率有显著差异(H=24 21;95%CI:0 46 177 99，P=0 002)。经过调整其他混杂因素后，P I 分型是预测 HCC 发生的独立指标(H=12.69;95%CI:4 63 34 80，P=0 002)。结论P I 分型和 Laennec 分级均能反应患者抗病毒治疗前后纤维化的特征及改变情况，其中 P I 分型对抗病毒治疗后纤维化的改变更敏感。P I 分型(治疗后)可用于预测抗病毒治疗后患者 HCC 发生的风险。关键词:乙型肝炎;肝硬化;癌，肝细胞;P I 分型;Laennec 分级基金项目:国家“十三五”科技重大专项(NCT01965418);北京市自然科学基金(7212101)Association of P I classification and Laennec grading with histology and prognosis after antiviral therapyin patients with hepatitis B cirrhosisLYU Caihong1，2，SONG Zheng1，2，LUO Jing1，3，CHANG Xiujuan2，YANG Yongping1，2(1 Peking University 302 ClinicalMedical School，Beijing 100039，China;2 Department of Hepatology，The Fifth Medical Center of PLA General Hospital，Bei-jing 100039，China;3 Department of Gastroenterology，Peking University Ditan Teaching Hospital，Beijing 100011，China)Corresponding author:YANG Yongping，yongpingyang hotmail com(OCID:0000 0002 8307 1095)Abstract:ObjectiveTo investigate the role of P I classification and Laennec grading in evaluating histological changesin patients with hepatitis B cirrhosis after receiving antiviral therapy，as well as the association of these two evaluation systemswith clinical prognosis MethodsA total of 218 patients from 14 centers were consecutively screened from October 2013 to085临床肝胆病杂志第39 卷第3 期2023 年3 月J Clin Hepatol，Vol39 No3，Mar2023October 2014，and these patients were diagnosed with liver cirrhosis based on pathology(Ishak score 5)，received antiviraltherapy for 72 weeks，completed two liver biopsies，and met the P I classification criteria The 218 patients were dividedinto non hepatocellular carcinoma(HCC)group with 186 patients and HCC group with 32 patients The chi square test andthe Fisher s exact test were used for comparison of categorical data between groups For the comparison of HCC after antiviraltherapy，the non parametric Mann Whitney U test was used for continuous variables，and for the comparison of P I classification and Laennec grading，the non parametric Kruskal Wallis H test was used for continuous variables Univariateand multivariate Cox regression analyses were used to calculate hazard ratio(H)and 95%confidence interval(CI)，and theKaplan Meier method was used to calculate the cumulative incidence rate of HCC esultsAfter 72 weeks of antiviral ther-apy，there was a significant difference in P I classification between the non HCC group and the HCC group(P 0.001)There were significant differences in the distribution of Laennec grading and P I classification before and afterantiviral therapy(P 0 001)After antiviral therapy，the 218 patients were divided into 4A group with 33 patients，4B groupwith 71 patients，and 4C group with 114 patients according to Laennec grading，and there were significant differences betweenthese three groups in platelet count(PLT)(H=36 429，P 0 001)，liver stiffness measurement(LSM)(H=13 983，P=0 004)，Ishak score(2=23 060，P 0 001)，and HAI score(P 0 001)After antiviral therapy，the 218 patients weredivided into group with 70 patients，I group with 52 patients，and P group with 96 patients according to P I classifica-tion，and there were significant differences between these three groups in PLT(H=7 193，P=0 028)，LSM(H=6 238，P=0 045)，Ishak score(2=7 986，P 0 001)，HAI score(P=0 002)，and HCC(P 0 001)There was a significantdifference in the incidence rate of HCC between the P and groups based on P I classification(H=24 21，95%CI:0 46 177 99，P=0 002)After adjustment for other confounding factors，P I classification was an independent pre-dictive factor for HCC(H=12 69，95%CI:4 63 34 80，P=0 002)ConclusionBoth P I classification andLaennec grading can reflect the features and changes of fibrosis before and after antiviral therapy，and P I classification ismore sensitive to fibrosis changes after antiviral therapy P I classification(after treatment)can be used to assess therisk of HCC in patients after antiviral therapyKey words:Hepatitis B;Li