血小板计数/脾径比值对肝硬化并食管静脉曲张的预测作用

目的:探讨血小板计数/脾径比值无创性预测肝硬化并食管静脉曲张的临床价值。方法:326例肝硬化患者入院时均行血生化、腹部超声及胃镜检查。血小板计数取患者住院期间3次平均值,B超测量脾脏最长径,并计算血小板计数/脾径比值。将326例肝硬化患者根据胃镜检查结果分为2组:有食管静脉曲张组136例和无食管静脉曲张组190例。并将相关数据进行统计分析。根据血小板计数/脾径比值的平均数和标准差来确定判断有、无食管静脉曲张的临界值,根据临界值预测有、无食管静脉曲张的存在,并与金标准比较,得出其真假阳性和真假阴性例数,并计算其敏感性、特异性、阳性预测值和阴性预测值。结果:326例患者中,临界值0.42时,敏感性、特异性、阳性预测值、阴性预测值分别为90%、96%、94%、92%;相关性分析结果显示,血小板计数与有、无食管静脉曲张呈无相关(r=0.1640、0.1328,P均>0.05),脾径与有食管静脉曲张呈正相关(r=0.2111,P<0.05),血小板计数/脾径与有食管静脉曲张呈正相关(r=0.2351,P<0.01)。结论:血小板计数/脾径比值可有效判断有、无食管静脉曲张的存在,是一个良好的无创预测指标。     

不同肝病模型诊断肝硬化食管胃静脉曲张的对比研究

目的对比天冬氨酸氨基转移酶-血小板比率指数（APRI）、血小板计数与脾脏直径比值（PC/SD）、血清腹水白蛋白梯度（SAAG）3种不同肝病模型诊断肝硬化食管胃静脉曲张（GOV）的准确性,并与增强CT比较,以期为临床筛选出诊断肝硬化GOV的最佳肝病模型。 方法选取2014年5月至2018年3月因肝硬化失代偿腹水收入常熟市第一人民医院住院的126例患者纳入研究。对患者行胃镜检查确诊是否存在GOV,并依据结果分为GOV组（51例）和非GOV组（75例）。收集患者相关检查数据并通过公式计算3种肝病模型APRI、PC/SD、SAAG的值,采用单因素分析（独立样本t检验）比较GOV组和非GOV组患者APRI、PC/SD、SAAG。将单因素分析差异有统计学意义的肝病模型进行多因素分析,通过基于偏最大似然估计的前进法二分类逐步logistic回归分析,筛选诊断GOV的有效肝病模型,并与增强CT比较受试者工作特征（ROC）曲线的曲线下面积（AUC）,使用Youden指数确定最佳判定点。 结果GOV组患者与非GOV组患者比较,APRI、SAAG值明显升高［（0.72±0.31）vs（0.54±0.18）,t=4.15,P<0.01;（21.62±3.14）g/L vs（15.87±1.78）g/L,t=13.08,P<0.01］,PC/SD值明显降低［（847.26±260.92）vs（1298.20±213.51）,t=-10.23,P<0.01］,差异具有统计学意义。经多因素回归分析,PC/SD、SAAG是诊断GOV的独立危险因素,建立回归方程：logistic（P）=-5.266＋0.707 SAAG–0.007 PC/SD。通过ROC曲线对比,PC/SD（0.86,95%CI=0.79~0.92）、SAAG（0.89,95%CI=0.83~0.94）比增强CT（0.73,95%CI=0.65~0.81）有着更大的AUC,即更高的诊断准确性,差异具有统计学意义（P均<0.01）;但PC/SD和SAAG之间AUC对比差异无统计学意义（P>0.05）。使用Youden指数确定最佳判定点发现,PC/SD<1123.4具有对肝硬化GOV最高的诊断准确性（敏感度92.2%、特异度66.7%）,SAAG>18.2g/L具有对肝硬化GOV最高的诊断准确性（敏感度86.3%、特异度85.3%）。 结论多种肝病模型中PC/SD、SAAG诊断肝硬化GOV准确性较高,且均优于增强CT,可在临床上作为胃镜发现肝硬化GOV的有效补充手段。     

慢性肝炎及肝硬化患者血小板计数的临床探讨

目的 探讨血小板计数(PLT)在慢性肝炎及不同程度肝硬化患者中的变化及临床意义.方法 采用日本Sysmex SF-3000全自动血细胞分析仪对慢性肝炎60例及肝硬化患者60例(按Child-Pugh分级:A级21例,B级22例,C级17例)、健康对照组100例的PLT进行检测,并将各组的变化进行比较分析.结果 慢性肝炎组和肝硬化组的PLT均显著减少(P＜0.01),随着肝硬化进程PLT减少更显著,与A级相比,B、C级的PLT更有显著变化(P＜0.01和P＜0.001).结论 外周PLT对评估慢性肝病的严重程度、出血倾向有重要的指导作用.     

二维剪切波弹性成像检测大鼠肝脾硬度评估临床显著性门静脉高压的比较

目的  分析二维剪切波弹性成像（2D-SWE）检测脾、肝脏硬度评估临床显著性门静脉高压的价值。方法  将50只雄性SD大鼠随机分为门脉高压组（PH组,n=25）和正常组（n=25）。PH组采用CCl4诱导法,正常组仅注射玉米油,于12周采用2D-SWE检测大鼠脾、肝脏硬度,运用门静脉主干直接穿刺法测量门静脉压力（PVP）,观察脾、肝脏病理改变。分析脾硬度（SS）、肝脏硬度（LS）与PVP相关性,以PVP为金标准求得ROC曲线下面积。结果  SS、LS与PVP均呈正相关关系,SS与PVP的相关性（r=0.797,P < 0.001）强于LS与PVP(r=0.505,P < 0.001)。以PVP≥10 mmHg作为金标准,2D-SWE检测SS、LS的ROC曲线下面积分别为0.875和0.673,SS优于LS（P < 0.05）。结论  2D-SWE测量SS评估临床显著性门静脉高压诊断效能优于LS。     

Serum zinc value in patients with hepatitis virus-related chronic liver disease: association with the histological degree of liver fibrosis and with the severity of varices in compensated cirrhosis

The relationships between the serum mineral concentrations and the endoscopic findings of esophageal varices have been poorly investigated. In this study, we investigated hepatitis virus-positive patients who had undergone a liver biopsy (n = 576) and 75 patients with compensated cirrhosis in order to evaluate the association of the zinc value with the severity of liver fibrosis and esophageal varices. The mean zinc values decreased with the progression of fibrosis (METAVIR score; F0–1: 71.3 ± 11.3, F2: 68.9 ± 11.7, F3: 66.3 ± 11.8, F4: 63.9 ± 15.0). In the hepatitis virus-related compensated cirrhosis, the mean zinc value decreased with the severity of varices (patients without varices: 66.3 ± 12.6, patients with low-risk varices: 62.5 ± 13.7, patients with high-risk varices: 55.6 ± 13.0). The zinc value was significantly lower in patients with varices than in those without varices (59.3 ± 13.6 vs 66.3 ± 12.6, p<0.05). The zinc value was also significantly lower in the patients with a high risk of bleeding than in those with a low risk (55.6 ± 13.0 vs 64.6 ± 13.1, p<0.01). These findings suggest that the zinc value is not only an indicator of an abnormal metal metabolism, but is also a simple parameter associated with hepatitis virus-related various conditions, including the degree of liver fibrosis and the severity of esophageal varices in compensated cirrhosis.     

RLLB/Alb ratio: a promising noninvasive diagnostic marker in assessing esophageal varices in cirrhotic patients

BackgroundEndoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non‐invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital.Participants and MethodsA total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades.ResultsThe upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut‐off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa (r = 0.630, p < 0.001).ConclusionThe RLLD/Alb ratio is a non‐invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.     

Contemporary use of elastography in liver fibrosis and portal hypertension

The risk and speed of progression from fibrosis to compensated and decompensated cirrhosis define the prognosis in liver diseases. Therefore, early detection and preventive strategies affect outcomes. Patients with liver disease have traditionally been diagnosed at an advanced stage of disease, in part due to lack of non-invasive markers. Ultrasound elastography to measure liver stiffness can potentially change this paradigm. The purpose of this review was therefore to summarize advances in the field of ultrasound elastography with focus on diagnosis of liver fibrosis, cirrhosis and clinically significant portal hypertension, techniques and limitations. Four types of ultrasound elastography exist, but there is scarce evidence comparing the different techniques. The majority of experience concern transient elastography for diagnosing fibrosis and cirrhosis in patients with chronic viral hepatitis C. That said, the role of elastography in other aetiologies such as alcoholic- and non-alcoholic liver fibrosis still needs clarification. Although elastography can be used to diagnose liver fibrosis and cirrhosis, its true potential lies in the possibility of multiple, repeated measurements that allow for treatment surveillance, continuous risk stratification and monitoring of complications. As such, elastography may be a powerful tool for personalized medicine. While elastography is an exciting technique, the nature of ultrasound imaging limits its applicability, due to the risk of failures and unreliable results. Key factors that limit the applicability of liver stiffness measurements are as follows: liver vein congestion, cholestasis, a recent meal, inflammation, obesity, observer experience and ascites. The coming years will show whether elastography will be widely adapted in general care.     

Development and progression of gastroesophageal varices in patients with chronic hepatitis C

Evaluation of: Fontana RJ, Sanyal AJ, Ghany MG et al. Factors that determine the development and progression of gastroesophageal varices in patients with chronic hepatitis C. Gastroenterology 138(7), 2321–2331 (2010).

Hepatitis C virus infection is the leading cause of chronic liver disease in the western world. Chronic liver diseases may cause, through portal hypertension, the development of gastroesophageal varices, which can then bleed. We assess the findings of a study aimed at identifying the incidence of de novo varix development and their progression in patients with chronic hepatitis C and advanced fibrosis. This study was a substudy of the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial. The HALT-C trial was designed to determine whether pegylated interferon (PEG-IFN) at low dose can reduce the rate of disease progression in these patients. Approximately 26% of patients developed de novo varices and 35.2% of patients with varices at baseline had variceal progression or bleeding during the 4-year follow-up. The authors examine demographic, clinical, laboratory, virological, endoscopic and histological factors associated with the development and progression of gastroesophageal varices. PEG-IFN-α2a therapy did not reduce the risk of development or progression of gastroesophageal varices.     

Noninvasive diagnosis of the degree of hepatic fibrosis using ultrasonography in patients with chronic liver disease due to hepatitis C virus

BACKGROUND: Chronic liver disease is characterized by progressive hepatic fibrosis and changes in hepatic haemodynamics. This study has addressed the possibility of a noninvasive diagnosis of the degree of hepatic fibrosis by evaluating the velocity of blood in the hepatic vasculature. Materials and methods The maximum velocity of blood at the portal vein and hepatic artery was measured in 80 patients with chronic liver diseases (19 with liver cirrhosis; 61 with chronic hepatitis) and in 20 normal volunteers by Doppler ultrasonography. The arterio-portal ratio (A/P ratio) was calculated by dividing the maximum velocity of blood (Vmax) in the hepatic artery with the Vmax in the portal vein. Multivariate analysis was used to disclose the independent predictors of the degree of hepatic fibrosis. RESULTS: The levels of A/P ratio were significantly higher in patients with liver cirrhosis (LC) compared to those with chronic hepatitis (CH) and normal controls. Probit analysis revealed that the value of A/P ratio at which CH becomes LC was A/P >or= 3.5. The levels of A/P ratio were also significantly higher in patients with severe fibrosis compared with mild (P < 0.0001) and moderate (P < 0.0001) fibrosis. Multivariate analysis disclosed right A/P ratio (P = 0.0001), left A/P ratio (P = 0.013), and platelet counts (P = 0.0172), as the only independent predictors of the degree of hepatic fibrosis. CONCLUSIONS: A/P ratio may be used for the noninvasive diagnosis of the degree of hepatic fibrosis in patients with chronic liver diseases.     

慢性乙型肝炎后肝硬化的临床分期及与血小板和凝血功能的关系

目的了解慢性乙型肝炎(简称乙肝)后肝硬化的临床分期、疾病发展与血小板、凝血功能的关系和变化规律。方法回顾性分析2008～2010年123例慢性乙肝后肝硬化不同临床分期住院患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和血小板计数(PLT)的检测结果,并以健康体检者为对照进行统计学分析。结果慢性乙肝后肝硬化代偿组和失代偿组PT、APTT均较对照组显著延长,而Fib含量明显减低,PLT显著减少,差异也统计学意义(P<0.05);失代偿组较代偿组PT、APTT均显著延长,Fib及PLT则均低于代偿组,差异也有统计学意义(P<0.05)。结论凝血功能和PLT与肝硬化患者的疾病进展程度密切相关,对了解其肝功能损害程度、判断预后具有一定诊断和治疗意义。     

血清RBP、凝血四项和血小板指标检测在重症肝病辅助诊断中的应用

目的探讨血清视黄醇结合蛋白(RBP)、凝血四项和血小板指标检测在重症肝病辅助诊断中的应用价值。方法随机选取2014年1月至2015年12月该院门诊及住院收治的110例重症肝病患者[43例急慢性重症肝炎患者(A组),36例肝硬化患者(B组)和31例肝癌患者(C组)]、38例非重症肝病患者和40例健康体检者(对照组)作为研究对象,对研究对象进行RBP、凝血四项指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原定量(Fib)]和血小板指标[血小板计数(PLT)、平均血小板体积(MPV)和血小板分布宽度(PDW)]检测。结果重症肝病中A组、B组和C组RBP、Fib和PLT水平低于对照组和非重症肝病组,PT、APTT、TT、MPV和PDW水平均明显高于对照组和非重症肝病组,差异均有统计学意义(P0.05或P0.01)。非重症肝病组RBP、Fib和PLT水平低于对照组,PT、APTT、TT、MPV水平高于对照组,差异均无统计学意义(P0.05)。结论 RBP、凝血四项和血小板指标是重症肝病辅助诊断中的重要检测指标,临床应加强对重症肝病患者以上指标的检测。     

全身炎症反应综合征对肝硬化患者的肝肾功能以及临床结局的影响

目的 研究肝硬化患者合并全身炎症反应综合征(SIRS)的发生率以及SIRS对肝肾功能和临床结局的影响.方法 选择我院收治的肝硬化患者203例作为研究对象,对其在住院期间的临床表现、实验室指标以及临床评分进行随访记录,并以患者死亡和出现门静脉高压并发症作为随访终点.结果 81例患者合并SIRS.合并SIRS组黄疸发病率、细菌感染率、白细胞计数升高、血红蛋白降低、血清肌酐升高、丙氨酸转氨酶升高、血清胆红素升高、国际标准化比值(INR)、心率、血清白蛋白降低和Child-Pugh评分升高密切相关,差异均具有统计学意义(均P＜0.05).合并SIRS组病死率、门静脉高压出血发生率、肝性脑病发生率以及1型肝肾综合征(HRS-1)均显著高于未合并SIRS组患者(均P ＜0.01).死亡患者SIRS发病率显著高于存活患者(P＜0.01).门静脉高压并发症患者SIRS发病率显著高于无门静脉高压并发症的患者(P＜0.01).SIRS和Child-Pugh分级评分是患者死亡(SIRS:OR=0.505,P＜0.01;Child-Pugh分级:OR =0.412;P＜0.01)和门静脉高压并发症(SIRS:OR=0.494,P＜0.01;Child-Pugh分级:OR =0.309;P＜0.01)的独立影响因素.结论 SIRS好发于中晚期肝硬化患者,且与门静脉高压并发症密切相关,合并SIRS的患者其病死率显著增高.     

肝尾叶与右叶径线及比值变化与非酒精性脂肪性肝病的关系

目的探讨肝尾叶与肝右叶的各径线及比值的变化与非酒精性脂肪性肝病之间的关系。方法选择在我院诊断为非酒精性脂肪性肝病变的病例147例及普通健康体检者227人为研究对象,分别测量其肝尾叶上下径、前后径、横径及肝右叶横径、最大斜径,计算肝尾叶横径与肝右叶的横径和肝尾叶上下径与肝右最大斜径比值,分析其与非酒精性脂肪性肝病之间的关系。结果健康成人肝尾叶与不同程度的脂肪肝病人肝尾叶的上下径、前后径、横径及肝右叶横径、最大斜径均在统计学上显著性差异（P<0.05）,在各径线中重度脂肪肝>中度脂肪肝>轻度脂肪肝>正常肝脏;轻、中、重度脂肪肝肝尾叶横径与肝右叶横径比值,以及肝尾叶上下径与肝右叶最大斜径比值均比较接近,无显著性差异。结论肝尾状叶与右叶各径线变化与非酒精性脂肪性肝病轻重程度密切相关,肝尾叶与右叶径线的（P>0.05）比值变化与非酒精性脂肪肝病轻重程度关系不密切。     

Elevation of Nepsilon-(carboxymethyl)lysine-modified advanced glycation end products in chronic liver disease is an indicator of liver cirrhosis

OBJECTIVES: Progression of liver fibrosis to cirrhosis is a dire consequence of chronic liver diseases (CLD). Nepsilon-(carboxymethyl)lysine (CML)-modified advanced glycation end products (AGEs) in patients with CLD could reflect the degree of severity of the disease. DESIGN AND METHODS: In 110 patients with CLD and 124 healthy controls, CML serum levels and their diagnostic sensitivity and specificity were determined and compared to hyaluronan (HA). RESULTS: Serum levels of CML were significantly affected by the stage of liver cirrhosis and were closely associated with liver function capacity. CML correlated positively with HA (r = 0.639, P < 0.0001). In ROC analysis, the diagnostic sensitivity and specificity in distinguishing healthy controls from liver disease patients for CML (AUC 0.908; 95%-CI 0.863-0.942, cut-off 640 ng/mL, sensitivity 74.5% and specificity 97.6%) resembled HA (AUC 0.948; 95%-CI 0.907-0.974; cut-off 50 ng/mL, sensitivity 80.7% and specificity 97.9%). The combination of CML and HA shows an AUC of 0.932; 95%-CI 0.888-0.962; sensitivity 82.6%; and specificity 95.8%. CONCLUSIONS: Our data suggest that serum levels of CML could provide a supplementary diagnostic marker for advanced stages of liver cirrhosis. However, the quality of interaction needs further investigation.     

Ammonia and glutamine metabolism in human liver slices: new aspects on the pathogenesis of hyperammonaemia in chronic liver disease

Ammonia and glutamine metabolism was studied in slices from normal, fatty and cirrhotic human livers. The liver disease was evaluated by histological examination. With respect to ammonia removal, urea and glutamine synthesis in human liver represent low and high affinity systems with k0.5(NH4+) values of 3.6 and 0.11 mM, respectively. Compared with normal control livers, cirrhotic livers showed a decreased glutamine synthesis from NH4Cl by about 80%. The same was true for urea synthesis. Conversely, flux through hepatic glutaminase was increased in cirrhosis 4-6-fold. These changes in hepatic glutamine and ammonia metabolism were observed regardless of whether reference was made to liver wet weight, DNA or protein content. Acetazolamide inhibited urea synthesis in cirrhotic liver slices by about 50%, indicating that mitochondrial carbonic anhydrase is required for urea synthesis also in cirrhosis. There was a significant correlation between the in-vitro determined capacity for urea synthesis from NH4Cl and the in-vivo determined plasma bicarbonate concentration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemodynamic and morphologic changes of peripheral hepatic vasculature in chronic liver disease: a preliminary study by contrast-enhanced coded phase-inversion harmonic sonography

To investigate whether observing the morphology of the peripheral hepatic vasculature and the hemodynamics of microbubble arrival time in these vessels can provide useful information for the diagnosis of liver disease, Five normal volunteers and 16 patients were studied by contrast-enhanced coded phase-inversion harmonic sonography. Vessel images of the peripheral vessels were observed in real time after intravenous injection of Levovist. The time when the microbubbles appeared in the peripheral vessels was measured. Three patterns of morphologic change of the peripheral hepatic vasculature were seen, marked, slight, and no abnormal changes. The microbubble arrival times at the peripheral vessels were all shorter in patients with cirrhosis than chronic hepatitis or normal subjects. Marked, slight, and no abnormal morphologic changes of the peripheral hepatic vasculature in patients with liver cirrhosis were found in five, one and zero of the six patients, respectively. Those patients with chronic hepatitis, were found in one, six and three of the ten patients, respectively. There was a significant difference among the different groups (P < 0.001). Evaluating the hemodynamics and morphology by contrast-enhanced coded pulse-inversion harmonic sonography may offer useful information in the diagnosis of liver disease.     

多项指标联合检测对乙型肝炎后肝硬化诊断治疗中的观察分析

目的探讨肝纤维化四项与天门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值、乙型肝炎病毒(HBV)DNA指标联合检测对乙型肝炎(简称乙肝)后肝硬化诊断治疗的临床应用价值。方法选择2009年5月至2011年5月在该院消化内科收治的130例乙肝后肝硬化患者,同时选择80例单纯慢性乙肝为对照组,检测其血清透明质酸(HA)、Ⅲ型前胶原蛋白(PⅢNP)、Ⅳ型胶原蛋白(Ⅳ-Col)、层黏连蛋白(LN)、AST/ALT比值及乙肝DNA(HBV-DNA)指标水平。结果 (1)乙肝后肝硬化血清中HA、Ⅳ-Col、PⅢNP、LN明显高于单纯慢性乙肝组(P<0.01)。(2)肝纤维化四项指标在乙肝后肝硬化血清中HBV DNA>106copy/mL组中除LN外,其他指标水平明显高于乙肝后肝硬化血清中HBV DNA在103～105copy/mL组和HBV DNA<103copy/mL组的水平,差异有统计学意义(P<0.01);在HBV DNA 103～105copy/mL和HBV DNA<103copy/mL两组间肝纤维化四项指标升高水平差异无统计学意义(P>0.05)。(3)肝纤维化四项指标水平在AST/ALT>2、12时为(785.2±216.4)μg/L,各组间差异有统计学意义(P<0.05);Ⅳ-Col升高水平在AST/ALT>2[(598.2±158.6)μg/L]和AST/ALT<1[(438.7±146.1)μg/L]组间差异统计学意义(P<0.05);PⅢNP和LN升高的水平在各组间差异无统计学意义(P>0.05)。结论联合检测肝纤维化四项与AST/ALT比值、HBV DNA有利于临床对乙肝后肝硬化患者病程的监测,同时为临床对乙肝后肝硬化患者的抗病毒和抗纤维化治疗及疗效的判定提供实验室依据。     

Gamma‐Glutamyl Transpeptidase‐to‐Platelet ratio predicts liver fibrosis in patients with concomitant chronic hepatitis B and nonalcoholic fatty liver disease

ObjectivesThe aim of this study was to compare the correlation of gamma‐glutamyl transpeptidase‐to‐platelet ratio (GPR), aspartate aminotransferase‐to‐platelet ratio index (APRI), fibrosis index‐4 (FIB‐4), and liver stiffness measurement (LSM) in the diagnosis of liver fibrosis, and perform a diagnostic value of GPR for predicting fibrosis in CHB patients with NAFLD.MethodsA retrospective study was conducted on CHB patients concurrent with NAFLD between September 2019 and December 2020. They were divided into control group (LSM ≤ 9.7 kpa) and fibrosis group (LSM ≥ 9.8 kpa). Demographic data were collected; ALT, AST, and PLT were also detected. LSM was measured by transient elastography (TE). The GPR, APRI, and FIB‐4 were calculated. The correlation between GPR, APRI, FIB‐4, and LSM was compared. The accuracy of predicting liver fibrosis using GPR, APRI, and FIB‐4 was assessed.ResultsEighty‐five CHB patients with NAFLD were enrolled. Multivariate analysis showed that age (p = 0.005), GGT (p = 0.001), and PLT (p = 0.013) were the independent risk factors for LSM. The GPR (p = 0.008), APRI (p = 0.001), and FIB‐4 (p = 0.001) values in fibrosis group were higher than control group. Pearson linear correlation was used to analyze the correlations between LSM and GPR, APRI, and FIB‐4. LSM was correlated with GPR, APRI, and FIB‐4. The AUCs of GPR, APRI, and FIB4 were 0.805, 0.766, and 0.826 in assessing liver fibrosis, respectively. No significant differences in the areas of GPR were comparable to that of APRI and FIB‐4.ConclusionGPR has a good correlation with LSM in assessing liver fibrosis and can be used as a noninvasive index for the assessment of liver fibrosis in patients with concomitant CHB and NAFLD.