Three noninvasive liver fibrosis evaluation methods in diagnosis of early cirrhosis for chronic HBV infected patients with mild abnormal liver function / 中华临床感染病杂志

ABSTRACT

Objective To compare FibroTouch, serum hepatic fibrosis index and aspartate aminotransferase-to-platelet ratio index (APRI) in diagnosis of liver fibrosis and early cirrhosis for patients with chronic HBV infection with mild abnormal liver function.Methods One hundred and seven chronic HBV infected patients with alanine transaminase (ALT)≤80 U／L who underwent liver biopsy in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to January 2017 were enrolled in the study.According to the liver biopsy pathology , the patients were divided into mild liver fibrosis group (S1, n＝26 ), significant fibrosis group ( S2-3, n ＝34 ) and early cirrhosis group ( S4, n ＝47 ).The differentiations of liver stiffness measurement (LSM), Laminin(LN), Collagen Type ⅢN-peptide(PⅢP N-P), Collagen Type IV(CⅣ), Hyaluronic acid ( HA) and APRI were compared among the three groups , and their correlations with fibrosis were analyzed with Spearman rank correlation analysis .Logistic regression analysis was performed to establish a multi-index model for predicting the degree of liver fibrosis , and the receiver operating characteristic (ROC) curves were drawn to compare and analyze the predictive value for different stages of liver fibrosis.Results The LSM in the significant fibrosis group was higher than that in the mild liver fibrosis group (Z＝-2.611, P＜0.01).The levels of PⅢP N-P,CIV,LN and HA in early cirrhosis group were higher than those in mild liver fibrosis group (Z＝-4.026,-4.205,-2.938 and-3.156, all P＜0.01).LSM and APRI in early liver cirrhosis group was higher than that in mild liver fibrosis group(Z＝-5.789 and -4.308, both P＜0.01) and significant liver fibrosis group (Z＝-3.460 and -3.498, both P＜0.01).PLT in early liver cirrhosis group was lower than that in mild liver fibrosis group and significant liver fibrosis group (Z＝-4.533 and -3.206, both P＜0.01).The correlation analysis showed that the values of LSM , CIV, PⅢP N-P and APRI were positively correlated with the stage of liver fibrosis (r＝0.606, 0.418, 0.396 and 0.470, respectively; all P＜0.01).There was no significant difference in the efficacy of each single index in predicting hepatic fibrosis S≥2 and S＝4 (all P＞0.05). The prediction of liver fibrosis models were established with Logistic regression analysis .The model 1 Logit (P)＝-3.810+0.385×LSM+0.052×CIV was used for predicting liver fibrosis S≥2; the area under the receiver operating characteristic curve ( AUC) was 0.839, with specificity of 96.0%, and the diagnostic efficacy was superior to PⅢP N-P, CⅣand APRI(Z＝2.579, 2.145 and 2.219, all P＜0.05), but there was no significant difference compared with LSM ( Z ＝1.001, P ＞0.05).The model 2 Logit ( P)＝-4.291+0.105×LSM+0.028×CIV+2.682×APRI was used for predicting liver fibrosis S ＝4; its AUC was 0.865 with sensitivity of 82.9%and specificity of 81.8%, and the diagnostic efficacy was superior to LSM, PⅢP N-P, CⅣand APRI (Z＝2.309, 2.485, 2.403 and 2.103, all P＜0.05).Conclusions For chronic HBV infected patients with mild abnormal liver function , FibroTouch can be selected as a noninvasive method to predict liver fibrosis S≥2.The diagnostic efficacy of the prediction model 2, based on the combination of LSM, CIV and APRI is superior to each single index , which can improve the prediction level of early cirrhosis.