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Objective To identify the high-risk factors and establish a nomogram for evaluating significant histological response (SHR) in chronic hepatitis B (CHB) patients receiving entecavir treatment. Methods Treatment-naive CHB patients who were presented to 14 hospitals, from October 2013 to October 2014, were enrolled and treated with entecavir for 72 weeks,prospectively. All the patients who underwent paired biopsies at treatment baseline and week 72 were analyzed. According to whether SHR (Ishak fibrosis score F≤2 points and histology activity index HAI≤4 points) was obtained during treatment, they were assigned to response group (n=160) and non-response group (n=567). High-risk factors were identified by multivariate logistic regression, and then were incorporated into a nomogram model. The discrimination, calibration and clinical applicability of nomogram were assessed by concordance index (C-index), calibration curve and clinical decision curve (DCA). Results After 72 weeks of treatment, regression of fibrosis, improvement of inflammation, virologic response, alanine aminotransferase (ALT)normalization and HBeAg seroconversion were 51.2%, 74.4%, 86.0%, 83.5% and 13.3%, respectively, however, 49.0% (306/625) of patients with virological response and 43.4% (165/380) of patients with ALT normalization did not achieved regression of fibrosis.Logistic regression analysis showed that baseline age (OR=0.978, 95%CI 0.958-0.998, P=0.030), platelet (PLT) (OR=1.005, 95%CI 1.001-1.010, P=0.030), liver stiffness measurement (LSM) (OR=0.931, 95%CI 0.892-0.972, P=0.001) and 72-week ALT (OR=0.980,95%CI 0.964-0.996, P=0.016), 72-week LSM (OR=0.858, 95%CI 0.782-0.941, P=0.001) were independent high-risk factors associated with SHR. The C-index of the nomogram model based on the above factors was 0.784, which was significantly better than 72-week AST/PLT ratio (APRI) (0.643), fibrosis-4 (FIB-4) (0.691) and LSM (0.735) alone, and had well-fitted calibration curves and DCA. Conclusions Incorporating baseline age, PLT, LSM, 72-week ALT and 72-week LSM, the established individualized nomogram model for evaluating significant histological response in CHB patients receiving antiviral therapy has good predictive performance and can reduce the need of liver biopsy.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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