The Clinical Study Of Fibroscan And Multi-parameter Model For Combined Diagnosis In Liver Fibrosis And Cirrhosis

Background：Liver fibrosis is a commonly chronic, progressive, diffuse liver injury. It is a clinicalsyndrome and a pathological state. It is the body’s repair of various chronic liver damage intraumatic reaction. Liver fibrosis will eventually progress to liver cirrhosis or liver cancer if it isnot be intervented and treated timely. It has become a consensus that liver fibrosis or earlycirrhosis can be reversed. Thus, the clinical diagnosis especially the early diagnosis of liverfibrosis and cirrhosis is essential for patients. The group leaded by Mentor Lixin Liu dedicated tothe pathogenesis of liver fibrosis and non-invasive early diagnosis. FibroScan (transientelastography ultrasound) is a noninvasive repeatable measurement of liver fibrosis in recentyears and has the advantages of accurate and efficient, non-invasive assessment. The correlationof FibroScan values and liver fibrosis is increased with the severity of liver fibrosis, up to 80%consistency with liver biopsy, can partially replace liver biopsy. The evaluation ofmulti-parameter model is simple by optimizing the combination of different biochemical markersand calculating the composite score by formula. The diagnostic accuracy of liver fibrosis orcirrhosis is higher than a single index in a single center and multi-center study. To analyze anddiscuss if the diagnostic accuracy of fibrosis and cirrhosis can be improved when FibroScan andAPRI, FIB-4, FibroIndex, multi-parameter model of liver fibrosis is combined, we conduct thestudy.Objective：To analyze the relationship and correlation of the FibroScan value and APRI, FIB-4,FibroIndex, multi-parameter models in liver fibrosis patients due to different causes and theirjointly diagnostic value for liver fibrosis and cirrhosis. To provide some clinical evidence fornon-invasive diagnosis of liver fibrosis.Methods：To collect the peripheral venous blood, clinical data and examine the serum markers ofalanine aminotransferase (ALT), aspartate aminotransferase (AST), globulin (G), platelet (PLT),and other indicators in fifty-five fibrosis patients, fifty-one cirrhosis patients due to varietycauses which have been diagnosed according to Liver fibrosis Integrative Medicine Guide (2006)and Cirrhosis diagnosis and treatment of Integrative Medicine (2004), fifty-five healthy controls. To calculate the model values of APRI、FIB-4、FibroIndex according to the formula and examineFibroScan simultaneously. To analysis the relationship and its relevance of FibroScan, threemodel values and liver fibrosis. To evaluate the lonely and united diagnostic value of FibroScanand APRI, FIB-4, FibroIndex, three multi-parameter models in liver fibrosis and cirrhosis. Toevaluate the diagnostic value of FibroScan and multi-parameter model using sensitivity,specificity and ROC curve.Results：In different causes of chronic liver disease patients, from the normal group without liverdisease, to the gradual accumulation of fibrous tissue of the liver fibrosis group, to the fibroustissue of excessive accumulation of liver cirrhosis three different pathological stages, themeasured values of FibroScan is upward trend. The difference is statistically significant (P<0.01).The difference of APRI, FIB-4, FibroIndex is statistically significant between liver fibrosis andcirrhosis group (P<0.05). The correlation analysis shows that APRI, FIB-4, FibroIndex havepositive correlation with FibroScan values (the correlation coefficient r were 0.278, 0.471, 0.464,P<0.05). The area under ROC curve (AUC) of APRI, FIB-4, FibrIndex, multi-parameter modelsfor liver fibrosis and cirrhosis is 0.741, 0.825, 0.826. The diagnostic value of the three modelsare moderate. The area under ROC curve (AUC) of FibroScan for liver fibrosis and cirrhosis is0.867. It have a higher diagnostic value than any of the APRI, FIB-4, FibroIndex, threemulti-parameter models. The area under ROC curve (AUC) of FibroScan for normal and liverfibrosis is 0.777 which is lower than liver fibrosis and cirrhosis.The AUC values can be wereincreased to 0.885, 0.895, 0.884 after the three multi-parameter models, APRI, FIB-4, FibrIndex,join with FibroScan. The diagnostic accuracy has been significantly improved. Further studyshowes that the diagnostic accuracy of the AUC values can be increased to 0.906, if FibroScan isjoined with APRI, FIB-4, FibrIndex. The diagnostic accuracy has reached the height.Conclusion：1. The values of FibroScan respectively has a positive correlation with APRI, FIB-4, FibroIndex,multi-parameter models.2. The diagnostic accuracy can be increased for liver fibrosis and cirrhosis after FibroScan isjoined with APRI, FIB-4, FibroIndex.