[Predictive value of liver pathologic changes in determining the effectiveness of entecavir treatment for chronic hepatitis B-An analysis of 1 366 cases].

Objective To analyze the relationship between baseline liver pathologic changes and the effectiveness of entecavir(ETV) and investigate the predictive value of baseline liver pathologic changes in determining the effectiveness of ETV, to provide reliable basis for precision medicine in patients with chronic hepatitis B(CHB). Methods A total of 1 366 cases with CHB were retrospectively recruited who underwent liver biopsy between January 2006 to June 2016 and were treated with ETV over 96 weeks.The relationship between baseline liver pathologic changes and the antiviral responses to ETV at 48, 96 weeks were compared. Results Liver pathology was employed to make the definite inflammation grade and the fibrosis stage.According to the liver inflammation and fibrosis, patients were divided into 4 groups(G1, G2, G3, G4 and S1, S2, S3, S4 respectively). The complete response rate of G1, G2, G3 and G4 after 48 weeks ETV treatment was 26.3%(10/38), 30.9%(121/391), 35.3%(101/286), 44.4%(52/117) respectively in HBeAg positive patients and was 61.5%(24/39), 80.4%(148/184), 82.4%(201/244), 88.1%(59/67) respectively in HBeAg negative patients.There was statistical difference in the complete response rates among liver inflammation grades both in HBeAg positive patients(χ2=8.510, P 0.05; χ2=6.729, P>0.05). The differences were still not statistical significant after 96 weeks ETV treatment (P>0.05). But after further grouping, whether HBeAg was positive or not, as the degree of fibrosis stage was aggravating, the complete response rate of G2, G3 and G4 after 48 weeks ETV treatment decreased at the same degree of inflammation grade and the differences were statistically significant (P<0.05). The differences were still statistical significant after 96 weeks ETV treatment (P<0.05). Conclusions The responses to ETV treatment are closely related with baseline liver pathology.The CHB patients with higher score of inflammation and lower score of fibrosis will have a good response to ETV treatment.The degree of inflammation grades and fibrosis stages can be used as early predictors of ETV treatment for CHB. Key words: Hepatitis B, chronic; Nucleosides; Biopsy, needle; Entecavir