The Value Of Liver Shear Wave Velocity Combined With APRI For Diagnosing Chronic Hepatitis B Fibrosis

ObjectiveTo evaluate the value of the liver shear wave velocity by ARFI detect the liver fibrosis. SWV is combined with the APRI in order to improve the diagnostic value of liver fibrosis of chronic hepatitis B.MethodsPart Ⅰ:To measure the liver shear wave velocity of147patients with chronic hepatitis B liver fibrosis patients and74healthy group by ARFI, repeat the above measurement valid data, effective data standards for success rate (SR)>60%, and the interquartile ratio of the measured value of the median (IQR/M)<30%. Calculate the average was included in the statistics. Fasting8hours for blood tests of liver function and blood and calculating aspartate amino transferase-platelet ratio index (APRI). Liver biopsy was done at the same day. The cases is divided into5groups by pathological degree of fibrosis. To analyse the distribution and differences in liver fibrosis and health group of SWV and APRI. Using Spearman correlation analysis of the SWV, AST, PLT, APRI, and liver fibrosis grading correlation.Part Ⅱ:Analysis area under the curve (Area under the receiver operating characteristic curve, AUROC) to determine the critical value of SWV and APRI to diagnose different degree of liver fibrosis of sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV).The z test was used to compare the two diagnostic methods for the diagnosis of liver fibrosis.Part Ⅲ:The risk of combining diagnose was predicted by logistic analysis. Draw the ROC curve with the prediction to assess the sensitivity, specificity, accuracy, and predictive value, positive predictive value and negative predictive value with combining method to diagnose of early liver fibrosis, Compare the separate SWV and APRI with combining method.Result:Part I:The SWV of Healthy group, S0, S1, S2, S3, S4is (1.13±0.09) m/s,(1.42±0.40) m/s (1.60±0.46) m/s (2.01±0.44) m/s,(2.36±0.34) m/s,(2.79±0.47) m/s seperately, APRI were0.18±0.01,0.18±0.03,0.27±0.12,0.38±0.27,1.23±0.72,2.0±1.77seperately, The difference of SWV with groups was significant difference by the one-way variance analysis.(F=138.152, P=0.000). Except for S0and S1level of liver fibrosis was no significant difference between the groups,the others (between the healthy group and S0, S1, S2, S3, S4, SO and S2, S3, S4between, S1and S2, S3, S4,, S2and S3, S4, between S3and S4) were significant differences (P<0.05). The difference of APRI with groups was significant difference by the one-way variance analysis (F=32.387, P=0.000). The healthy group and S3, S4, SO and S3, S4, S1and S3, S4,, S2and S3, S4, there is a significant difference (P<0.05), the rest of the group without significant difference. Spearman correlation analysis showed that SWV were correlation with AST, PLT, APRI and pathological staging.(0.845,0.482,-0.494,0.671,P=0.000).Part II:SWV (APRI) diagnostic S0vsS1234(hepatic fibrosis) the S01vsS234(significant fibrosis), S012vsS34(severe liver fibrosis) S0123vsS4(cirrhosis) AUROC were0.843(0.818)0.916(0.846),0.932(0.912)0.918(0.859)seperately; the cutoff were1.99m/s (0.24),1.99m/s (0.46),2.23m/s (0.57),2.27m/s (0.72); the sensitivities were63.0%(75.6%),83.9%(74.7%),86.2%(80.0%),100%(80.4%); the specificities were95.0%(100%),86.7%(100%),89.0%(97.6%),76.2(86.1%); the accuracies were85.0%(85.7%),82.3%(81.0%),86.4%(89.8%),85.3%(79.6%). The diagnosis of the AUROC by SWV was greater than the APRI,in addition to the area under the curve S012vsS34was no statistically significant difference with each other (P=0.5472), the area under the curve of the other phases of were statistically significant (P<0.05).Part III:The combining method to diagnosis S0vsS1234S01vsS234by ROC curve.The AUROC were0.909,0.943, sensitivities were70.9%,89.7%, specificities were100%,90%, and accuracies were89.1%,89.8%. The AUROC were higher than the separate SWV, or APRI to diagnosis liver fibrosis.(P<0.05) The sensitivity, specificity, accuracy, PPV, NPV were improved than SWV separate, more accuracy improved than APRI. Conclusion:Part I:SWV and APRI and was increased with the severity of liver fibrosis, SWV was better than APRI in refining the early staging of liver fibrosis. SWV APRI was correlated with pathologic.Part II:SWV and APRI has good diagnostic value for liver fibrosis diagnosis is relatively, but the diagnostic value of early diagnosis of liver fibrosis was low. the value for setere liver fibrosis of SWV APRI was the same, the SWV diagnostic of other groups was greater than APRI.Part III:The Combing SWV and APRI can improve the diagnostic value of the early stage of liver fibrosis.