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Platelets’ increase is associated with improvement of liver fibrosis in entecavir-treated chronic hepatitis B patients with significant liver fibrosis

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Abstract

Background and aim

Reduction of platelet count is often observed in chronic hepatitis B (CHB) patients with significant liver fibrosis. In this cohort study, we investigated whether platelets’ increase after entecavir (ETV) therapy was associated with the improvement of liver fibrosis.

Methods

We collected the data of a cohort 82 CHB patients with paired liver biopsies before and after 78-week ETV therapy, and assessed the platelets’ change following the treatment and further investigated the associated clinical factors with platelets’ change.

Results

Platelet count increased after treatment, which occurred mainly in patients with low baseline level of platelet count (< 200 × 109/L) or with significant fibrosis (Ishak ≥ 3). Regression analysis showed that baseline platelet count was the main factor associated with post-treatment increase of platelets (β = − 0.215, p = 0.015). In patients with significant fibrosis, correlation and linear regression analysis revealed that post-treatment platelets’ increase was correlated with improvement of liver fibrosis assessed by reduction of quantitative collagen percentage area (r = 0.392, p = 0.006) (β = 2.449, p = 0.035), but no correlation between changes in platelet counts and Ishak fibrosis score. Receiver operating curve analysis showed an increase of 12.5 × 109/L in platelet count could identify improvement of liver fibrosis (AUC = 0.70).

Conclusion

Platelets’ increase after ETV therapy was associated to the improvement of liver fibrosis with reduction of collagen percentage area in CHB patients with significant fibrosis.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUC:

Area under the curve

CHB:

Chronic hepatitis B

CHC:

Chronic hepatitis C

CI:

Confidence interval

CPA:

Collagen proportionate area

ETV:

Entecavir

SHG:

Second-harmonic generation

TPEF:

Two-photon excitation fluorescence

ROC:

Receiver operating curve

References

  1. World Health Organization. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Geneva. 2015.

  2. American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261–83.

    Article  Google Scholar 

  3. Association for the study of the liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167–85.

    Article  Google Scholar 

  4. Marcellin P, Gane E, Buti M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet. 2013;381:468–75.

    Article  PubMed  CAS  Google Scholar 

  5. Liaw YF. Reversal of cirrhosis: an achievable goal of hepatitis B antiviral therapy. J Hepatol. 2013;59:880–1.

    Article  PubMed  Google Scholar 

  6. European Association for Study of Liver. EASL-ALEH clinical practice guidelines. Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63:237–64.

    Article  Google Scholar 

  7. American Association for the study of liver diseases. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management. Hepatology. 2017;65:310–35.

    Article  Google Scholar 

  8. Coverdale SA, Samarasinghe DA, Lin R, et al. Changes in antipyrine clearance and platelet count, but not conventional liver tests, correlate with fibrotic change in chronic hepatitis C: value for predicting fibrotic progression. Am J Gastroenterol. 2003;98:1384–90.

    Article  PubMed  CAS  Google Scholar 

  9. Taniguchi H, Iwasaki Y, Fujiwara A, et al. Long-term monitoring of platelet count, as a non-invasive marker of hepatic fibrosis progression and/or regression in patients with chronic hepatitis C after interferon therapy. J Gastroenterol Hepatol. 2006;21:281–7.

    Article  PubMed  Google Scholar 

  10. Meer AJ, Maan R, Veldt BJ, et al. Improvement of platelets after SVR among patients with chronic HCV infection and advanced hepatic fibrosis. J Gastroenterol Hepatol. 2016;31:1168–76.

    Article  PubMed  CAS  Google Scholar 

  11. Kim WR, Berg T, Asselah T, et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016;64:773–80.

    Article  PubMed  CAS  Google Scholar 

  12. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696–9.

    Article  PubMed  CAS  Google Scholar 

  13. Xu S, Wang Y, Tai DC, et al. qFibrosis: a fully-quantitative innovative method incorporating histological features to facilitate accurate fibrosis scoring in animal model and chronic hepatitis B patients. J Hepatol. 2014;61:260–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tai DC, Tan N, Xu S, et al. Fibro-C-Index: comprehensive, morphology-based quantification of liver fibrosis using second harmonic generation and two-photon microscopy. J Biomed Opt. 2009;14:044013.

    Article  PubMed  CAS  Google Scholar 

  15. Sun Y, Zhou J, Wang L, et al. New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment. Hepatology. 2017;65:1438–50.

    Article  PubMed  CAS  Google Scholar 

  16. George SL, Bacon BR, Brunt EM, et al. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: a 5-year follow-up of 150 patients. Hepatology. 2009;49:729–38.

    Article  PubMed  CAS  Google Scholar 

  17. Koh C, Heller T, Haynes-Williams V, et al. Long-term outcome of chronic hepatitis C after sustained virological response to interferon based therapy. Aliment Pharmacol Ther. 2013;37:887–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Morgan TR, Ghany MG, Kim HY, et al. Outcome of sustained virological responders with histologically advanced chronic hepatitis C. Hepatology. 2010;52:833–44.

    Article  PubMed  CAS  Google Scholar 

  19. Caballero T, Pérez-Milena A, Masseroli M, et al. Liver fibrosis assessment with semiquantitative indexes and image analysis quantification in sustained-responder and non-responder interferon-treated patients with chronic hepatitis C. J Hepatol. 2001;34:740–7.

    Article  PubMed  CAS  Google Scholar 

  20. Goodman ZD, Becker RL Jr, Pockros PJ, Afdhal NH. Progression of fibrosis in advanced chronic hepatitis C: evaluation by morphometric image analysis. Hepatology. 2007;45:886–94.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors are thankful to the staff of participating institutions.

Author information

Author notes

  1. Lin Wang and Bingqiong Wang were co-first authors making an equal contribution.

Authors and Affiliations

  1. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China

    Lin Wang, Bingqiong Wang, Hong You, Xiaoning Wu, Jialing Zhou, Xiaojuan Ou & Jidong Jia

Authors
  1. Lin Wang
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  2. Bingqiong Wang
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  3. Hong You
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  4. Xiaoning Wu
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  7. Jidong Jia
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Corresponding author

Correspondence to Jidong Jia.

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Conflict of interest

Lin Wang, Bingqiong Wang, Hong You, Xiaoning Wu, Jialing Zhou, Xiaojuan Ou, and Jidong Jia do not have anything to disclose regarding potential conflicts of interest.

Ethical approval

The study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki (2008 revision), and the protocol of study was approved by the Ethics Committee of Beijing Friendship Hospital. Our study had been registered in the ClinicalTrials.gov (NCT01938781 and NCT01938820).

Financial support

This study was supported by the grant of National Science and Technology Major Project (2013ZX10002004) and Key Project from Beijing Municipal Science and Technology Commission (D121100003912003).

Informed consent

The written informed consent was obtained from every patient prior to initiating any study procedures.

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Wang, L., Wang, B., You, H. et al. Platelets’ increase is associated with improvement of liver fibrosis in entecavir-treated chronic hepatitis B patients with significant liver fibrosis. Hepatol Int 12, 237–243 (2018). https://doi.org/10.1007/s12072-018-9864-z

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  • DOI: https://doi.org/10.1007/s12072-018-9864-z

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