The Correlation Between The Ratio Of Ineffective Hepatic Blood Flow To Total Hepatic Blood Flow And The Degree Of Liver Fibrosis In Patients With Chronic Hepatitis B

Object:To investigate the correlation between the ratio of ineffective hepatic blood flow to total hepatic blood flow and the degree of liver fibrosis in patients with chronic hepatitis B and its feasibility as a noninvasive diagnostic marker for liver fibrosis.Methods:To select chronic hepatitis B patients hospitalized in Henan Provincial People’s Hospital who have undergone liver biopsy examination during the period from December 2015 to December 2017,using a prospective study method.Among them,156 patients confirmed as chronic hepatitis B through pathological diagnosis.These patients were divided into 5 groups based on the degree of liver fibrosis confirmed by liver biopsy,including 18 cases in the no liver fibrosis group(S0);26 cases in the mild liver fibrosis group(S1);35 cases in the significant liver fibrosis group(S2);43 cases in the severe liver fibrosis group(S3);34 cases in the early cirrhosis group(S4).To collect clinical data and the peripheral venous blood to examine the serum markers of aspartate aminotransferase(AST),alanine aminotransferase(ALT),platelet(PLT),albumin(ALB),total bilirubin(Tbil).The ratio of aspartic aminotransferase to platelets(APRI)and the fibrosis index based on the 4 factor(FIB-4)was calculated according to the formula.The liver stiffness measurement,total hepatic blood flow,effective hepatic blood flow were measured by Fibroscan,liver ultrasound and ICG test,and then calculate the ratio of ineffective hepatic blood flow and total hepatic blood flow.To analysis the relationship and correlation of the IHBF/THBF ratio,LSM,APRI,FIB-4 with the degree of liver fibrosis,and to evaluate the value of IHBF/THBF ratio,LSM,APRI and FIB-4 in the diagnosis of liver fibrosis with sensitivity,specificity and area under the ROC curve(AUC).Results:The clinical data of five groups with different degrees of liver fibrosis were compared between groups.The results showed no significant difference in age,AST,ALT,ICG K value and THBF(P>0.05).The differences of PLT,LSM,APRI,FIB-4,ICG R15,EHBF,IHBF and IHNF/THBF ratio were statistically significant(P<0.05).Spearman rank correlation analysis showed that IHBF / THBF ratio,LSM,APRI and FIB-4 were positively correlated with liver fibrosis stage,the correlation coefficient r were 0.775,0.565,0.461,0.415,P<0.001.In the diagnosis of liver fibrosis is ≥S1,the receiver operating characteristic curve(ROC)showed that the area under the curve of IHBF/THBF ratio is lower than LSM,higher than that of APRI and FIB-4.In the diagnosis of liver fibrosis is ≥S2,≥S3 and S4,the area under the curve of IHBF/THBF ratio was higher than that of LSM,APRI and FIB-4.With the increase of liver fibrosis,the AUC,Younden index and truncation value of IHBF/THBF ratio increased gradually.The sensitivity,specificity,positive predictive value and negative predictive value of IHBF / THBF ratio were higher than 82%,64%,74% and 50%,respectively,in diagnosing different degree of hepatic fibrosis.In the diagnosis of liver fibrosis is ≥S3,the sensitivity was the highest,reaching 89.6%.The specificity,positive predictive value and negative predictive value of the S4 phase were maximum,which were 94.1%,83.66% and 96.63%,respectively.Conclusion:1、The IHBF/THBF ratio was positively correlated with the degree of hepatic fibrosis.2、The IHBF/THBF ratio has higher accuracy in the diagnosis and prediction of different degrees of liver fibrosis in patients with chronic hepatitis B,and is more efficient than non-invasive diagnostic indicators such as LSM,APRI,and FIB-4.3、As the degree of liver fibrosis increases,the diagnostic efficiency of the IHBF/THBF ratio increases.