Assessment Of Chronic Hepatitis B-Related Hepatic Fibrosis By Fibroscan Stiffness Measurement Compared With Ultrasonography

Objective:Liver fibrosis is a most common way of various chronic liver diseases processing into the late stage. For diagnosis, the gold standard is a comprehensive pathological liver biopsy. However, a thorough "comprehensive" pathological liver biopsy can only be achieved through surgical excision, which remains the problem in actual clinical practice. Thus, a practical reliable and non-invasive way to help diagnose liver fibrosis is in urgent demand. In recent years, the technique of non-invasive instant transient elasography (TE) on liver stiffness measurement has been applied to assessing the degree of liver fibrosis in clinical practice, with the most common one being the instant transient scanning system generally called Fibroscan (FS) developed by Echosens Company. This research aims to discuss the assessment of chronic Hepatitis B-related hepatic fibrosis by Fibroscan stiffness measurement compared with ultrasonography, which is used to assess the stiffness degree and to determine whether liver fibrosis can be examined by FS. And thus free patients with chronic hepatitis B from the needling biopsy of liver.Methods:Select 163 cases as object of study, including 107 patients diagnosed with chronic hepatitis B and 56 healthy people. Carry out liver biopsy on the 107 patients.Clarify them into S0-S4 sub-groups with pathological fibrosis analysis as the gold standard, and there are 104 cases had liver fibrosis(stage:S1～S4) in them, the 56 healthy people and 3 cases with diagnosed liver fibrosis stage for SO consist of the control group,fibrosis degree of the control group being the SO sub-group level. Examine every patient with both FS and ultrasonic examination. And then mark the USG for semi-quantitative score through Indexes and comprehensive integral method. Analyze the relevance of the stiffness parameter and the marks of the USG to the degree of the liver fibrosis. Last, both ways will be tested in aspects of sensitiveness and differences by applying the receiver operating characteristic curve (ROC).Results:(1)The stiffness parameter between different groups which is designed to detect the degree of liver fibrosis has significant difference (P<0.05)(2)There are also significant differences in the degree when using ultrasonic examination to observe the liver parenchyma, capsule, edge and vein. (P<0.05).(3)The stiffness parameter and the final score of hepatic parenchyma coming from ultrasonic examination to observe the liver's biopsy, capsule, edge and vein, have a relatively good correlation with pathology the degree of liver fibrosis,and the related coefficient (r=0.85,0.83,0.79,0.80,0.80,0.74, P<0.05),and all of these, the correlation between the liver stiffness parameter is the best.(4)The ROC curve analysis showed that the areas under the curve for stiffness, hepatic parenchyma to observe the liver's biopsy, capsule, edge and vein and theirs total score are0.85,0.83,0.79,0.80,0.80and0.84 respectively, and the area of the stiffness parameter is larger than others, so.it is the most valuable to be used to diagnosis.Conclusions:1.Fibroscan is a quantitative liver fibrosis detection means, and it can be used alone or combined with other ways in liver fibrosis to give an accurate evaluation.2.The score has good correlation with liver fibrosis degree, but it is influenced by the operator subjective judgment, the inspection instrument and other factors.so the results can only give a reference and can't be used to give an accurate result about the disease.3. Because there is good correlation with stiffness parameter pathology the degree of liver fibrosis and we can get a standard and accurate result, what's more, it features convenience, quickness, non-invasive, security and repeated inspection, which are easy to be accepted by the doctors and patients, so the examination is more suitable for those patients who have had liver fibrosis to review or have a long-term dynamic observation. so as to avoid liver biopsy for those patients with chronic hepatitis B. 4.Diagnosis of liver fibrosis with pathology is still as the golden standard.