Non-invasive Diagnostic Indicators and Antiviral Treatment Efficacy in CHB Patients with Different Liver Histopathological Degrees
Authors: Chen Feng , Li Qianhui , Xu Xiaomin , Wang Fei 
Published: August 2024

Background: Hepatic inflammatory and fibrotic lesions promote the development of cirrhosis and hepatocellular carcinoma in patients with chronic Hepatitis B (CHB). Early recognition of hepatic histopathological changes and timely initiation of antiviral therapy can delay or even reverse disease progression. Objectives: This study aimed to analyze non-invasive diagnostic indicators associated with different inflammation grades, fibrosis stages, and Hepatitis degrees in CHB patients, and their outcomes after antiviral therapy. Methods: A total of 91 CHB patients treated at the Third People's Hospital of Shenzhen from January 2016 to December 2019 were selected for inflammation grading (G) and fibrosis staging (S) based on liver puncture examination results. The patients were further divided into mild, moderate, and severe chronic Hepatitis groups. Correlation analysis was conducted via Spearman. The diagnostic performance of the relevant indexes for inflammation grading, fibrosis staging, and Hepatitis degree grading was evaluated using receiver operator characteristics (ROC). The performance of different ROC curves was further compared using the DeLong test. The effects of antiviral drugs on patients with different liver histopathological degrees were comparatively analyzed after 24, 48, 72, and 96 weeks. Results: Data analysis at baseline showed that 86.81% (79 of 91) of all patients were male. Additionally, about 61.54% (16 of 26), 30.77% (8 of 26), 85.19% (23 of 27), and 62.96% (17 of 27) of patients with normal ALT had G ≥ 2, G ≥ 3, S ≥ 2, and S ≥ 3, respectively. Inflammation grade, fibrosis stage, and Hepatitis degree were positively correlated with portal vein internal diameter, spleen thickness, LN, GPR, FIB-4, and S-index, and negatively correlated with PLT (P < 0.05). The area under the curve (AUC) of the ROC-assessed multifactorial combinations PSBPTL, PSWPAHPCL, and PSWPHCL for predicting the risk of developing G ≥ 3 inflammation, S ≥ 3 fibrosis, and moderate-to-severe Hepatitis in patients with CHB were 0.806, 0.843, and 0.778, respectively. The diagnostic accuracies were higher than some of these factors applied individually and some commonly used serological markers. HBV DNA levels were significantly lower in different Hepatitis groups after 24 weeks of antiviral therapy than before treatment (P < 0.05). Furthermore, the ALT normalization rate and HBV DNA clearance rate were slightly higher in the moderate and severe groups than in the mild group after 48 weeks of treatment (P > 0.05). The serum Hepatitis B envelope antigen (HBeAg) level was significantly lower in the severe group than in the mild group after 72 weeks of antiviral therapy (H = 7.043, P = 0.030). Although only the HBeAg serologic conversion rate was significantly different at 96 weeks among the three groups (χ2 = 12.389, P = 0.002), HBeAg-negative and the serologic conversion rates were higher in the severe group at each time point than in the mild and moderate groups. Conclusions: Multiple non-invasive indicators are strongly associated with different degrees of liver histopathology in patients with chronic HBV infection. Therefore, PSBPTL, PSWPAHPCL, and PSWPHCL can be used to predict the risk of developing G ≥ 3 inflammation, S ≥ 3 fibrosis, and moderate-to-severe Hepatitis in these patients, respectively. Moreover, short-term antiviral therapy has a more pronounced effect on patients with severe Hepatitis by improving hepatic inflammation and inhibiting viral replication.