Résumé
Objective To compare the diagnostic values of γ-glutamyl transpeptidase-to-platelet ratio index (GPRI) ,aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for chronic hepatitis B (CHB) fibrosis and cirrhosis .Methods According to the Metavir score ,262 CHB patients were divided into F0 — F1 group (n= 131) ,F2 — F3 group (n= 102) and F4 group (n = 29 ) . The age , gender , alanine aminotransferase (ALT ) , aspartate aminotransferase (AST ) ,γ-glutamyl transpeptidas (γ-GT ) and platelet count were recorded .GPRI ,APRI ,Fib-4 scores were calculated separately .Statistical analysis was performed by t test ,Kruskal-Wallis H test ,and χ2 test .The correlations between serum models and liver fibrosis stages were analyzed using the Spearman test .Results The scores of GPRI in F0 — F1 group ,F2 — F3 group and F4 group were 0 .39 (0 .21 , 0 .95) ,1 .05 (0 .38 ,2 .39) and 2 .11 (1 .12 ,3 .33) ,respectively .The difference was statistically significant (χ2 = 40 .645 ,P< 0 .01) .APRI scores in the three groups were 0 .49 (0 .32 ,0 .97) ,0 .77 (0 .52 ,1 .52) and 1 .12 (0 .77 ,2 .50) ,respectively .The difference was statistically significant (χ2 = 32 .636 , P < 0 .01) . Fib-4 scores in the three groups were 1 .36 (0 .92 ,2 .05) ,2 .34 (1 .28 ,4 .35) and 3 .86 (3 .03 ,8 .99) , respectively .The difference was statistically significant (χ2 = 48 .943 , P< 0 .01) .Age ,γ-GT ,AST and liver fibrosis were all positively correlated with liver fibrosis (r = 0 .322 ,0 .301 and 0 .199 ,respectively , all P< 0 .05) .Platelet was negatively correlated with liver fibrosis (r = — 0 .455 , P< 0 .05) ,while ALT was not significantly associated with hepatic fibrosis (r= 0 .111 ,P= 0 .073) .GPRI ,APRI and Fib-4 were positively correlated with liver fibrosis (r = 0 .625 ,0 .417 and 0 .399 ,respectively ,all P < 0 .05) .The areas under the operating characteristic curve of GPRI for significant hepatic fibrosis , advanced liver fibrosis and cirrhosis were 0 .818 ,0 .864 and 0 .837 ,respectively .APRI for significant hepatic fibrosis , advanced liver fibrosis and cirrhosis were 0 .694 ,0 .766 and 0 .722 ,respectively ,while Fib-4 were 0 .696 , 0 .770 and 0 .724 ,respectively .The low cutoff values of GPRI for various stages of liver fibrosis were 0 .99 ,1 .04 and 1 .06 ,respectively ,and the sensitivity ,specificity ,positive predictive value (PPV ) and negative predictive value (NPV) were all higher than those of APRI and Fib-4 .The high cutoff values of GPRI for liver fibrosis at each stage were 2 .49 ,3 .69 and 6 .77 , respectively , and the sensitivity , specificity ,PPV and NPV of the diagnosis were all higher than those of APRI and Fib-4 .Conclusion The diagnostic value of GPRI for CHB liver fibrosis is higher than those of APRI and Fib-4 .