FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化(S2～S4期),严重纤维化(S3～S4期)和肝硬化(S4期).以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例(1.4%),S1期49例(23.1%),S2期66例(31.1%),S3期50例(23.6%),S4期44例(20.8%),即显著纤维化者(S2～S4期)160例(75.5%),严重纤维化者(S3～S4期)94例(44.3%),肝硬化者(S4期)44例(20.8%).FIB-4指数对3个判定点的AUC值分别为0.733(95%(CI:0.660～0.806,P<0.01)、0.746(95%CI:0.679～0.813,P<0.01)、0.756(95%CI:0.687～0.825,P<0.01).结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.     

FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化(S2～S4期),严重纤维化(S3～S4期)和肝硬化(S4期).以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例(1.4%),S1期49例(23.1%),S2期66例(31.1%),S3期50例(23.6%),S4期44例(20.8%),即显著纤维化者(S2～S4期)160例(75.5%),严重纤维化者(S3～S4期)94例(44.3%),肝硬化者(S4期)44例(20.8%).FIB-4指数对3个判定点的AUC值分别为0.733(95%(CI:0.660～0.806,P<0.01)、0.746(95%CI:0.679～0.813,P<0.01)、0.756(95%CI:0.687～0.825,P<0.01).结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.     

156例轻度慢性乙型肝炎患者肝组织病理学研究

目的 探讨临床诊断为轻度慢性乙型肝炎患者的肝组织病理学特点及其肝穿刺活检的重要意义.方法 选择156例轻度慢性乙型肝炎患者进行肝穿刺活检及肝组织病理学检查,对临床诊断与病理诊断的结果进行对比分析.结果 经病理诊断为轻度慢性乙型肝炎者为105例,临床诊断与之的符合率为67.3%(105/156),中度28例(18.0%)、重度3例(1.9%)、肝硬化20例(12.8%);另外,肝组织炎症分级为G3～4者共48例(30.8%),纤维化分期为S3～4者共39例(25.0%);病理诊断为轻度慢性乙型肝炎与非轻度者之间的ALT、AST、Tbil和ALB水平差异无统计学意义.结论 对于临床诊断轻度慢性乙型肝炎患者最好行肝脏穿刺活检,以便更好指导诊断和抗病毒治疗.     

血清肝纤维化指标及PAPP指数与肝纤维化的相关性研究

目的探讨血清肝纤四项,即Ⅳ型胶原（C-Ⅳ）、透明质酸（HA）、层黏连蛋白（LN）、Ⅲ型前胶原氨基端肽（PⅢNP）以及PAPP指数,即凝血酶原时间（PT）、血清谷丙转氨酶（ALT）、全血血小板（PLT）计数、血清前白蛋白（PA）与肝纤维化的相关性。 方法选取行肝穿病理活检的不同程度肝纤维化患者80例（慢性肝炎60例、肝硬化20例;〈S0期34例、S1～S2期26例、S3～S4期20例）,分别采集静脉血。采用化学发光法检测血清中C—IV、HA、LN、PIIINP的水平,并分别应用全自动血液凝固仪、全自动生化分析仪和全自动全血细胞分析仪测定血清PAPP指数,分析各血清学指标与肝纤维化的相关性。 结果①各血清学指标水平均随肝纤维化程度的不断加深而升高,并均在S3～S4期达到最高水平,其中〈S0期患者血清HA水平与S1-S2期相比差异有统计学意义（t值为3．357,P〈0．05）;〈S0期患者血清C—IV、HA、LN、PIIINP、PAPP指数水平分别与S3～S4期相比差异均有统计学意义（t值分别为5．270、10．484、4．952、5．382、6．343,均P〈0．05）;S1～S2期患者血清C—IV、HA、LN、PⅢNP、PAPP指数水平分别与s3～S4期相比差异均有统计学意义（t值分别为4．322、6．992、4．393、3．838、4．027,均P〈0．05）;②各血清学指标与肝纤维化程度均呈正相关（r值分别为0．600、0．549、0．599、0．529、0．675,均P〈0．001）;③肝纤四项与PAPP指数的灵敏度（Se）、特异性（sp）、阳性预测值（Pv＋）、阴性预测值（Pv-）形成互补;④慢性肝炎患者血清PAPP指数水平与肝硬化患者相比差异有统计学意义（t值为1177．500,P〈0．001）。 结论肝纤四项与PAPP指数的联合检测有助于肝纤维化的临床诊断与分期以及对抗纤维化的疗效监测。     

HBeAg阴性慢性乙型肝炎患者血清病毒载量与肝组织学改变的关系

目的 探讨HBeAg阴性慢性乙型肝炎患者血清HBV DNA水平与肝组织损害的关系.方法 以HBeAg阳性慢性乙型肝炎病例为对照,回顾分析HBeAg阴性慢性乙型肝炎患者血清HBVDNA水平与肝组织病理炎症分级、纤维化分期之间的关系.结果 HBeAg阴性与阳性组HBV DNA 平均含量分别为（5.38±1.27）log10拷贝/ml和（6.80±1.18）log10拷贝/ml,差异有统计学意义（P〈0.01）.与HBeAg阳性组比较,HBeAg阴性组肝组织炎症分级及纤维化分期较高（P〈0.01）.HBeAg 阴性患者HBV DNA水平与肝组织炎症分级及纤维化分期呈正相关（P〈0.01）.结论 HBeAg阴性慢性乙型肝炎病毒载量低,乙肝病毒载量与肝损害呈正相关.     

慢性乙肝病毒感染者肝脏病理与临床特征研究

目的 探讨肝活检病理组织学对慢性乙型肝炎病毒（HBV）携带者和血清ALT轻度升高慢性乙型肝炎患者（CHB）的临床意义.方法 105例慢性HBV感染患者全部进行肝组织活检,并按血清ALT水平分为3组：ALT≤0.5×正常参考值上限（ULN）为A组,0.5×ULN＜ALT≤1×ULN为B组,1×ULN＜ALT＜2×ULN为C组;对3组肝脏炎症程度及纤维化程度比较,并对不同肝组织炎症程度、纤维化程度与患者基本情况的关系进行分析.结果 105例患者中炎症程度≥G2者占40.95%,其中ALT正常的患者有30.43%≥G2;纤维化程度≥S2者占26.67%,其中ALT正常的患者中≥S2者占17.39%.血清ALT及透明质酸随肝脏炎症程度加重及纤维化分期的增加而增加（P＜O.05）.结论 密切随访血清ALT和透明质酸可协助了解肝脏病变情况,肝脏病理学依据仍然是决定是否抗病毒治疗的有力依据.     

慢性乙型肝炎患者肝脏病理特点与血清HBeAg和HBV DNA的关系

目的 了解慢性乙型肝炎患者病理特点与血清HBeAg和HBVDNA的关系.方法对1057例慢性乙型肝炎患者进行肝脏病理检查,采用荧光定量PCR法检测血清HBV DNA,用化学发光法检测血清HBeAg.结果 HBeAg阴性的慢性乙型肝炎患者的炎症及纤维化程度(G4和S4分别为7.83%和12.17%)较HBeAg阳性的慢性乙型肝炎患者高(G4和S4分别为3.39%和5.44%);HBeAg阳性的患者中HBV DNA滴度低的患者炎症及纤维化程度较高(HBV DNA 104～105 G3G4和S3S4分别为45.64%和30.20%),而HBeAg阴性的患者则是HBV DNA滴度高的炎症及纤维化程度较高(HBV DNA106～107 G3G4为54.55%和HBV DNA 108～109S3S4为42.85%).结论慢性乙型肝炎患者的肝脏病理与血清HBeAg及HBV DNA水平有不同相关性,对HBeAg阴性的慢性乙型肝炎患者要及早进行肝脏病理检查和抗病毒治疗.     

慢性乙型肝炎患者肝功能及血清HBeAg和HBV DNA载量与肝组织病理相关性的研究

目的 探讨慢性乙型肝炎患者肝功能、HBeAg及HBV DNA水平与肝组织病理炎症分级和纤维化分期的关系.方法 选择233例慢性乙型肝炎患者进行肝穿病理学检查,同时所有患者检测HBV DNA、HBeAg及肝功能,比较患者的肝功能、HBeAg及HBV DNA水平在不同病理炎症分级及纤维化分期中的差异情况.结果 不同的炎症分级患者中,ALT以C3组最高,G0～1组最低,各组间比较差异有统计学意义(P =0.016);TBil以G4组最高,G0～1组最低,各组间比较差异有统计学意义(P=0.000);HBV DNA载量各组间差异无统计学意义.不同的纤维化分期患者中,ALT各组间比较差异无统计学意义;TBil以S4组最高,S2组最低,各组间比较差异有统计学意义(P=0.039);HBV DNA载量各组间差异无统计学意义.炎症分级为G3～4的患者比例在HBeAg阳性组与阴性组差异无统计学意义.纤维化分期S3～4的患者比例在HBeAS阳性组(38%)比HBeAg阴性组(53%)低,两组差异有统计学意义(P=0.025).结论 慢性乙型肝炎患者血清HBV DNA水平的高低不能反映其肝脏炎症及纤维化程度,HBeAg阴性慢乙肝患者肝组织纤维化程度较高,TBil水平与肝组织炎症分级及纤维化分期均有良好的相关性,ALT水平与炎症分级有一定的关联性,但与纤维化分期无关.     

实时剪切波弹性成像对慢性乙型肝炎肝纤维化程度的诊断价值研究

目的 探讨实时剪切波弹性成像（SWE）对乙型肝炎肝纤维化程度的诊断价值。方法 选择62例慢性乙型肝炎肝纤维化病人，其中男性41例，女性21例；年龄35～68岁，平均年龄51.8岁；病程2～6年，平均病程3.1年。对其分别进行SWE检查及血清学指标检测，对肝进行活检；并与病理肝纤维化程度进行比较。结果 病理诊断S1期8例，S2期31例，S3期23例。随着慢性乙型肝炎病人肝纤维程度的升高，其S1期、S2期、S3期丙氨酸氨基转移酶（ALT）(59.4 U/L±1.6 U/L、73.6 U/L±1.9 U/L、95.6 U/L±2.5 U/L)、天冬氨酸转氨酶（AST）(51.5 U/L±1.2 U/L、65.6 U/L±1.7 U/L、80.9 U/L±2.8 U/L)及总胆红素（TBiL）(15.3μmol/L±3.8μmol/L、17.6μmol/L±4.5μmol/L、26.6μmol/L±4.9μmol/L)逐渐升高（P <0.05）;SWE技术测量S1期、S2期、S3期弹性模量分别为（5.9±1.2） kPa、（8.5±2.6） kPa、（17.3±5.0） kPa，差异有统...     

非侵袭性指标S指数与血清HA联合诊断慢性乙肝肝纤维化的临床应用

目的:探讨慢性乙型肝炎(CHB)肝纤维化非侵袭性诊断指标S指数与血清透明质酸(HA)联合应用的临床诊断价值.方法:对76例CHB患者行肝活检分期,参照有关文献通过γ﹣谷氨酰转肽酶(GGT)、血小板(PLT)和白蛋白(Alb)三个常规项目计算S指数[S指数=1000×GGT/(PLT×Alb2)],同时应用放射免疫分析测定血清HA.结果:单用S指数(以0.1为阴性界值,0.5为阳性界值)作为排除和诊断显著肝纤维化的指标,可避免44.7%(34/76)的肝活检,其准确率为73.5%(25/34);用HA对未被S指数确定的42例患者进行再评价,又可避免57.1%(24/42)的肝活检,其准确率为79.2%(19/24);将S指数与血清HA进行联合应用,则可避免76.3%(58/76)的肝活检,其准确率为75.9%(44/58).结论:S指数与血清HA的联合应用及动态监测可提高无创评估CHB肝纤维化的诊断效率,减少或避免肝活检.     

Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV/hepatitis C virus-coinfected patients

BACKGROUND: Chronic hepatitis C in HIV-infected patients is an increasing cause of death dependent on the development of liver fibrosis, which is currently assessed by liver biopsy despite its limitations. Liver stiffness measurement, a new noninvasive method, allows the evaluation of liver fibrosis. The aim of this prospective study was to assess the accuracy of liver stiffness measurement for the detection of fibrosis and cirrhosis in HIV/hepatitis C virus (HCV)-coinfected patients and to compare its accuracy with other noninvasive methods. METHODS: We studied 72 consecutive HIV patients with chronic hepatitis C who had a simultaneous liver biopsy and liver stiffness measurement by transient elastography (FibroScan; Echosens, Paris, France) for the assessment of liver fibrosis. RESULTS: Liver stiffness values ranged from 3.0 to 46.4 kilopascal. Liver stiffness was significantly correlated to fibrosis stage (Kendall tau-b = 0.48; P < 0.0001). The area under the receiver operating characteristic (AUROC) curve of liver stiffness measurement was 0.72 for F > or = 2 and 0.97 for F = 4. For the diagnosis of cirrhosis, AUROC curves of liver stiffness measurement were significantly higher than those for platelet count (P = 0.02), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (P = 0.0001), Aspartate aminotransferase-to-Platelet Ratio Index (APRI) (P = 0.01), and FIB-4 (P = 0.004). CONCLUSION: Liver stiffness measurement is a promising noninvasive method for the assessment of fibrosis in HIV-infected patients with chronic HCV infection. Its use for the follow-up of these patients should be further evaluated.     

Predictive performance of eLIFT for liver inflammation and fibrosis in chronic liver diseases

Objective: The easy liver fibrosis test (eLIFT) is a novel predictor of liver fibrosis in chronic liver disease (CLD). This study aimed to evaluate the predictive value of the eLIFT for liver inflammation and fibrosis in CLD patients.Methods: We enrolled 1125 patients with CLD who underwent liver biopsy. The predictive accuracy for liver inflammation and fibrosis of the eLIFT was assessed and compared to that of the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 score (FIB-4), and gamma-glutamyl transpeptidase-to-platelet ratio (GPR) by ROC (Receiver Operating Characteristic) analysis and decision curve analysis (DCA).Results: The areas under the ROC curves (AUROCs) of the eLIFT for assessing liver inflammation G ≥ 2 and G ≥ 3 were 0.77 (0.75-0.80) and 0.81 (0.79-0.84), with cut-offs of 8.0 and 11.0, respectively. The AUROCs of the eLIFT for predicting fibrosis stages S ≥ 2 and S4 were 0.72 (0.70-0.76) and 0.76 (0.72-0.80), with cut-offs of 9.0 and 10.0, respectively. In discriminating G≥2 inflammation, the AUROC of the eLIFT was better than that of the FIB-4, with no difference compared with the GPR, but lower than that of the APRI. When discriminating G≥3 inflammation, the AUROC of the eLIFT was comparable to that of the APRI and GPR but superior to that of the FIB-4. There were no significant differences between the four indexes for predicting S≥2 and S4.Conclusion: The eLIFT is a potentially useful noninvasive predictor of liver inflammation and fibrosis in patients with CLD.     

红细胞分布宽度与血小板计数比值在乙型肝炎肝硬化患者病情评估中的作用

目的 探讨红细胞分布宽度与血小板计数比值在乙型肝炎肝硬化患者诊断及预后评估的关系。方法 选择2013年1月~2015年12月我院诊断为乙型肝炎肝硬化的患者144例、慢性乙型肝炎患者80例及同期健康体检者80例作为研究对象,收集其住院和（或）门诊检查资料,记录一般实验室检查结果,如血RDW、PLT、ALT、AST,计算基于血清学指标的模型,即RPR、APRI、FIB-4、Child-Pugh评分。相关性分析采用Spearman相关分析,绘制ROC曲线、计算AUC来判断RPR对肝硬化的预测价值。运用Kaplan-Meier法分析高RPR组与低RPR组乙型肝炎肝硬化患者3年生存率,同时将RPR、Child-Pugh评分纳入Cox回归分析,绘制54例乙型肝炎肝硬化死亡患者ROC曲线,判断RPR对乙型肝炎肝硬化患者预后的预测价值。结果 乙肝组、肝硬化组RPR分别为（0.33±0.16）Fl/(109/L）、（1.24±1.55）Fl/(109/L）,均高于健康体检组的（0.24±0.05）Fl/(109/L）,统计学意义显著(P＜0.01);肝硬化组RPR高于乙肝组,统计学意义显著（P＜0.01）。RPR与乙型肝炎肝硬化呈正相关（r=0.66,P＜0.01）。RPR预测乙型肝炎肝硬化的AUC为0.91,优于APRI,次于FIB-4,差异有统计学意义（P＜0.05）。RPR、FIB-4、APRI诊断乙型肝炎肝硬化的最佳界值分别为0.43、3.00和0.79（P＜0.01）,敏感度分别为84.00%、82.60%、84.00%,特异度分别为90.00%、95.00%和76.20%。RPR与Child-Pugh评分及MELD均呈正相关,r值分别为0.35、0.34（P＜0.01）。高RPR组和低RPR组在随访3年期间生存率分别为56.80%和68.60%,差异无统计学意义（P＞0.05）。结论 RPR可用于乙型肝炎肝硬化的诊断,RPR预测乙型肝炎肝硬化患者死亡的敏感性好,但特异性差,联合RPR可提高CP评分对乙肝肝硬化患者的预后评估效果。     

Subgroup analysis of the predictive ability of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) for assessing hepatic fibrosis among patients with chronic hepatitis C

BackgroundThere are many laboratory indices to assess liver fibrosis. Aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) index have been used as well-known serum markers of liver fibrosis. With the increasing use of non-invasive fibrosis assessment, it is important to recognize the limitations of these tests. The factors influencing the diagnostic accuracy to evaluate liver fibrosis are not well-established. This study aimed to perform a subgroup analysis of the predictive ability of laboratory indices.MethodsOverall, 113 patients with chronic hepatitis C infection who underwent liver biopsy were retrospectively examined. The histological assessment of liver fibrosis was performed using the METAVIR scoring system, and the values of several laboratory tests were also evaluated on the same day. We categorized our study population by treatment status, body mass index (BMI), and age.ResultsThe two laboratory indices APRI and FIB-4 index could predict advanced (F3-4) liver fibrosis and cirrhosis (F4), with the area under the receiver operating characteristic curve (AUROC) > 0.8 and accuracy >70%. The AUROCs and accuracies were higher among patients with sustained virological response (SVR) than among those without SVR. A higher predictive ability was also observed among patients with BMI <25 kg/m². Age did not appear to affect liver fibrosis predictability.ConclusionsThe laboratory indices APRI and FIB-4 index exhibit good diagnostic performance for determining advanced fibrosis and cirrhosis among patients with hepatitis C infection. The diagnostic accuracy appears better among patients with SVR and those with BMI <25 kg/m².     

Limited reliability of five non-invasive biomarkers in predicting hepatic fibrosis in chronic HCV mono-infected patients opposed to METAVIR scoring

BackgroundLiver biopsy is gold standard for fibrosis assessment in hepatitis C virus (HCV) infection but its limitations led to the identification of non-invasive biomarkers. This study assesses the reliability of five biomarkers in estimating the stage of liver fibrosis/cirrhosis in chronic HCV patients versus METAVIR scoring.MethodsOne hundred HCV monoinfected patients who underwent liver biopsy and blood sampling were included. Liver fibrosis was staged (F0–4) and required laboratory tests were performed. AAR, API, APRI, FIB-4 and Pohl score were calculated and their receiver operating curves (ROCs), sensitivities, specificities, predictive values and accuracies were evaluated.ResultsThere were 27, 44, and 29 patients at F0–F1, F2–F3, and F4 groups. Significant statistical differences were found regarding AST, vireamia, platelet count, prothrombin time and all biomarkers. From ROCs only Pohl score predicted significant fibrosis and cirrhosis but with low accuracy. AAR, API and APRI showed moderate performance at low cut-offs, but had limited predictive values or accuracies at higher cut-offs. FIB-4 was the least accurate test. The diagnostic reliability of these biomarkers was limited to patients with suspected insignificant fibrosis.ConclusionsThis study verified the limited reliability for AAR, API, APRI, FIB-4 and Pohl score in estimating the stage of hepatic fibrosis in HCV infected patients opposed to METAVIR scoring.     

Development of a novel glycated protein-based fibrosis prediction score for determination of significant liver fibrosis in HCV-infected patients,a preliminary study

The current study aimed to investigate the diagnostic value of glycated albumin (GA), glycated hemoglobin (HbA1c), and a number of routine biomarkers as noninvasive indicators of liver fibrosis in patients with chronic hepatitis C (CHC). One hundred patients with CHC were subjected to full medical history and examination, in addition to ultrasound-guided liver biopsy and histopathological examination for assessment of liver fibrosis stage. GA and HbA1c values, GA/HbA1c ratio, liver function tests, complete blood count, and alpha fetoprotein (AFP) were determined. A novel noninvasive index, dubbed Fibrosis Prediction Score (FPS), was selected for predicting significant liver fibrosis based on total bilirubin, glycated albumin, platelet count, age, and AFP. A validation study for FPS was applied on archival data which include 66 diabetics' patients. The FPS had area under the curve (AUC) of 0.92 for classification of patients with significant fibrosis with 81% sensitivity and 95% specificity. The AUCs of FPS in predicting advanced fibrosis and cirrhosis were 0.86 and 0.82, respectively. Comparison of AST-to-platelet ratio index (APRI) and FIB-4 with FPS indicated increased sensitivity and specificity of FPS over APRI and FIB4 in both significant and advanced fibrosis. FPS has a good sensitivity and specificity for prediction of significant and advanced liver fibrosis in patients with CHC.     

Expression of tumour necrosis factor-related apoptosis-inducing ligand and caspase-3 in relation to grade of inflammation and stage of fibrosis in chronic hepatitis C

AIM: To assess whether the distribution of the recently described proapoptotic ligand, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), and the apoptosis effector, caspase-3 alters with the degree of inflammation and fibrosis present in liver biopsy specimens from patients with chronic hepatitis C virus infection. METHODS AND RESULTS: Expression of TRAIL and caspase-3 was assessed immunohistochemically in liver biopsy specimens obtained from 89 adults with chronic hepatitis C. Expression of TRAIL in hepatocytes correlated inversely with stage of fibrosis (P = 0.001), classified according to the Scheuer score; expression of caspase-3 in hepatocytes correlated with grade of inflammation (P = 0.012). Expression of TRAIL in hepatocytes was not correlated with grade of inflammation (P > 0.05); expression of caspase-3 was not correlated with stage of fibrosis (P > 0.05). Maximum expression of proapoptotic TRAIL protein was observed in cases with low grade inflammation (G0) and low stage fibrosis (S1). Maximum expression of caspase-3 in hepatocytes was observed in cases with high grade inflammation (G3-4) and high stage fibrosis (S3), but not with liver cirrhosis (S4). CONCLUSIONS: There is a significant decrease in TRAIL expression with increasing grade of inflammation, whereas caspase-3 expression is significantly increased with advanced fibrosis, short of cirrhosis.     

Globulin–platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels

The globulin–platelet model (GP) is a new noninvasive liver fibrosis model developed in chronic hepatitis B (CHB) patients. This study aimed to evaluate the diagnostic performance of GP model for liver fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase (ALT) levels. We enrolled 316 CHB patients with HBV DNA ≥ 4 log 10 copies/mL and 40 IU/L < ALT ≤ 80 IU/L. The GP, aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were calculated. Using liver histology as a gold standard, the diagnostic performances of noninvasive fibrosis models were compared by the area under receiver operating characteristic curves (AUROCs). Of 316 patients, 146 (46.2%), 64 (20.3%) and 40 (12.7%) were classified as having significant fibrosis, severe fibrosis and cirrhosis, respectively. To predict significant fibrosis, the AUROC of GP was lower than APRI (0.64 vs 0.76, p < 0.001) and equivalent to FIB-4 (0.64 vs 0.66, p = 0.366). To predict severe fibrosis, the AUROC of GP was equivalent to APRI (0.82 vs 0.79, p = 0.409) and FIB-4 (0.82 vs 0.77, p = 0.224). To predict cirrhosis, the AUROC of GP was higher than APRI (0.91 vs 0.84, p = 0.033) and FIB-4 (0.91 vs 0.80, p = 0.004). GP is a more accurate noninvasive fibrosis model than APRI and FIB-4 to diagnose cirrhosis in CHB patients with high HBV DNA and mildly elevated ALT levels. The clinical application of GP model may reduce the need for liver biopsy in CHB patients.