| Objective: To investigate if the level of AFP could represent inflammation and fibrosis stages in liver of patients with CHB, and to evaluate its diagnostic value for liver pathological stages. Methods: Both liver biopsy samples and sera were collected in patients with CHB in our unit during March 2005 to December 2009 consecutively. The pathological analysis of biopsy sample was distinguished 5 levels to inflammation (G) and fibrosis (S) stages separately, which in expression of G 0~4 and S 0~4. The mean value of AFP were calculated at different liver inflammation and fibrosis stages. The comparison of the mean value between two groups is performed using variance analysis, and the comparison of the mean value of more than two ordered groups is performed using Kruskal-Wallis H rank sum test, and the comparison between either two groups using Mann-Whitney U rank sum test. The relationships between AFP and liver pathological stages were analyzed using Spearman rank correlation analysis. ROC curve was used to evaluate the diagnostic value of AFP for liver pathological stages. Using Binary Logistic regression to analyze evidently relevant indicators, we built the liver pathology-predicting models of Model A using the evidently relevant indicators including AFP and models of Model B using the indicators without AFP, then the models were analyzed by ROC curve. Results: Totally 621 patients with CHB were collected into this study, male were 508, female were 113. There were 157 (25.28%) cases with an elevated AFP. The mean value of AFP (ng/ml) at liver inflammation Stages G0 to G4 were ( X±S) 6.050±6.067, 12.281±47.815, 7.885±17.435, 35.364±122.037, 120.496±234.497. Rank sum tests showed that the five groups of mean value above were different, the differences existed between Stage G1 and G3,G1 and G4,G2 and G3,G2 and G4,G3 and G4. Similarly, the mean value of AFP at liver fibrosis Stages S0 to S4 were ( X±S) 4.806±5.010, 7.302±16.854, 11.226±44.708, 27.551±80.441, 99.286±219.023, rank sum tests showed that the five groups of mean value above were different, the differences existed between Stage S0 and S3, S0 and S4,S1 and S2,S1 and S3,S1 and S4,S2 and S3,S2 and S4,S3 and S4. Spearman rank correlation analysis showed that there was correlation between AFP and liver inflammation and fibrosis stages, the correlation coefficients were 0.439,0.408. ROC curve analysis for evaluating the value of AFP for judging inflammation stages G≥3 revealed that AUC was 0.729. The specificity of judging G≥3 was higher than 90% when AFP was higher 12.0ng/ml. ROC curve analysis for evaluating the value of AFP for judging fibrosis stages S≥3 revealed that AUC was 0.719, and the specificity of judging S≥3 was higher than 90% when AFP was higher 12.8ng/ml. Binary Logistic regression analysis showed that ALB, AST, CHE and AFP are independent predictors of Models for predicting liver inflammation. The AUCs of Model A and Model B for liver inflammation are 0.754 and 0.736. Binary Logistic regression analysis showed that AFP, CHE, PT and log10(HBV-DNA) are independent predictors of Models for predicting liver fibrosis. The AUCs of Model A and Model B for liver fibrosis are 0.756 and 0.730. Conclusions: The AFP level relates to inflammation and fibrosis stages in liver of patients with CHB in a low positive trend. Though in lower sub-clinical level, AFP could be used to index pathological stage, to some extent. The liver pathology is predicted to be moderate to severe when AFP is higher than 12.8ng/ml. The models built using AFP, ALB, AST, CHE, PT, PLT, HBV-DNA have mild diagnostic values for liver pathological stages.
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