Patients with stage 3 compared to stage 4 liver fibrosis have lower frequency of and longer time to liver disease complications.
Patients with stage 3 compared to stage 4 liver fibrosis have lower frequency of and longer time to liver disease complications.
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DOI：
10.1371/journal.pone.0197117
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Singal AK
中科院分区：
文献类型：
--
作者：
Axley P;Mudumbi S;Sarker S;Kuo YF;Singal AK
晚期肝纤维化是肝脏疾病进展和死亡率的重要预测因素，目前的指南建议一旦患者发生F3纤维化，就应筛查肝硬化并发症。我们的研究比较了肝活检3期（F3）和4期（F4）纤维化患者的肝脏疾病进展和生存率。对F3或F4患者进行肝活检，随访肝病并发症（静脉曲张出血、腹水和肝性脑病）、肝细胞癌和生存期（总生存期和无移植生存期）的回顾性研究。在2002年1月至2012年12月期间接受肝活检的2488例患者中，共分析了294例（171例F3）。在3年的中位随访期内，F4患者（平均年龄53岁，63%男性）与F3相比（平均年龄49岁，43%男性）5年累积失代偿概率较高（38% vs. 14%，p<0.0001），包括静脉曲张出血（10% vs. 4%，p = 0.014）、腹水（21% vs. 9%，p = 0.0014）和肝性脑病（14% vs. 5%，p = 0.003）。F4患者的5年总生存率（80% vs. 93%，p = 0.003）和无移植生存率（80% vs. 93%，p = 0.002）也较低。活检后5年内肝细胞癌的概率在F3和F4之间相似（1.2% vs. 2%，p = 0.54）。与F4期相比，F3纤维化患者发生肝病并发症的风险降低，生存率更高。建议进行前瞻性设计良好的研究，采用大样本量并克服本研究中发现的局限性，以确认和验证这些发现，作为修改晚期纤维化和3期肝纤维化患者随访指南和建议的基础。
Advanced liver fibrosis is an important predictor of liver disease progression and mortality, and current guidelines recommend screening for complications of cirrhosis once patients develop F3 fibrosis. Our study compared liver disease progression and survival in patients with stage 3 (F3) and stage 4 (F4) fibrosis on liver biopsy. Retrospective study of patients with F3 or F4 on liver biopsy followed for development of liver disease complications (variceal bleeding, ascites, and hepatic encephalopathy); hepatocellular carcinoma, and survival (overall and transplant free survival). Of 2488 patients receiving liver biopsy between 01/02 and 12/12, a total of 294 (171 F3) were analyzed. Over a median follow up period of 3 years, patients with F4 (mean age 53 years, 63% male) compared to F3 (mean age 49 years, 43% male) had higher five year cumulative probability of any decompensation (38% vs. 14%, p<0.0001), including variceal bleed (10% vs. 4%, p = 0.014), ascites (21% vs. 9%, p = 0.0014), and hepatic encephalopathy (14% vs. 5%, p = 0.003). F4 patients also had lower overall 5-year survival (80% vs. 93%, p = 0.003) and transplant free survival (80% vs. 93%, p = 0.002). Probability of hepatocellular carcinoma in 5 years after biopsy was similar between F3 and F4 (1.2% vs. 2%, p = 0.54). Compared to F4 stage, patients with F3 fibrosis have decreased risk for development of liver disease complications and better survival. Prospective well designed studies are suggested with large sample size and overcoming the limitations identified in this study, to confirm and validate these findings, as basis for modifying guidelines and recommendations on follow up of patients with advanced fibrosis and stage 3 liver fibrosis.
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