Primary Study On The Diagnostic Value Of Red Blood Cell Distribution Width、Mean Platelet Volume And Red Blood Cell Distribution Width To Platelet Ratio To Estimate The Degree Of Hepatic Fibrosis In Patients With Chronic Hepatitis B

Objectives:Hepatitis B virus infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide.Liver biopsy is a gold-standard method to assess the severity of liver fibrosis,but the invasive nature of this method limits its usage.Currently,noninvasive methods are utilized to estimate liver histology.In the present study,we aimed to assess the value of red blood cell distribution width (RDW)、mean platelet volume(MPV) and red blood cell distribution width to platelets ratio(RPR) for noninvasive diagnostic in estimating the degree of hepatic fibrosis in patients with chronic hepatitis B(CHB).Methods:A total of 76 biopsy-proven CHB cases in the department of digestive system from January 2012 to July 2015 in the second hospital affiliated to Kunming Medical University were included in the study.Record the gender、age、weight、 height、RDW、MPV、platelet(PLT) count and collected the stage of liver histology.Analysing if there were differences in RDW、MPV、PLT and RPR of patients with CHB between the S1-S4 groups.Then analysing the correlation between RDW、PLT、RPR、MPV and hepatic fibrosis stage and the diagnosis value of RDW、 MPV、RPR in estimating the hepatic fibrosis S≥2 and S=4.Results:1.With the increase in the severity of liver fibrosis,the level of platelet count gradually decreased((202.92±53.00)x10∧9/1,(167.25±64.26)x10∧9/1,(136.53±53.31) x10∧9/1,(115.70±56.22)x10∧9/1),the levels of RDW(13.30%(12.70%,14.00%), 13.15%(12.93%,13.65%),13.60%(12.60%,14.35%),14.45%(14.13%,15.18%))graduall y increased,the levels of RPR(0.07±0.02,0.10±0.04,0.12±0.06,0.16±0.07) gradually increased,which had significant differences between the S1-S4 groups (P<0.001, P=0.006,P<0.001,respectively),the differences of MPV(10.70fl (10.05fl,11.85fl),10.90fl(10.15fl,11.85fl),10.80fl(10.30fl,12.35fl),12.40fl(11.73fl, 13.45fl) between S1-S4 was not significant(P=0.055).2.The PLT of patients with CHB hepatic fibrosis stage S4 was lower than S2、S1,the difference were significant(P=0.019,P=0.000),the PLT of patients with hepatic fibrosis stage S3 was lower than S1(P=0.000), the PLT of patients with hepatic fibrosis stage S2 was lower than S1(P=0.033),the difference of PLT between S4 and S3 was not significant(P=0.365).The RDW of patients with CHB hepatic fibrosis stage S4 was larger than S3、S1,the difference were significant(P=0.026,P=0.010),the difference of RDW of patients with hepatic fibrosis between S3 and S2、S1 were not significant(P>0.05,respectively),the difference of RDW between S2 and S1 was not significant(P>0.05).The RPR of patients with CHB hepatic fibrosis stage S4 was larger than S3、S2、S1,the difference were significant(P=0.038,P=0.001,P=0.000), the RPR of patients with hepatic fibrosis S3 was larger than S1,the difference was significant(P=0.002),the difference of RPR between S3 and S2,the difference of RPR between S2 and S1 was not significant,respectively(P=0.174,P=0.057).3.Spearman rank correlation analysis:the Spearman rank correlation analysis showed that there was a significantly negative correlation between PLT and hepatic fibrosis stage(r=-0.506,P=0.000),a slight positive correlation between RDW and hepatic fibrosis stage (r=0.281,P=0.014),a slight positive correlation between MPV and hepatic fibrosis stage(r=0.260,P=0.023),a significantly positive correlation between RPR and hepatic fibrosis stage(r=0.539,P<0.001).4.Receiver operating characteristic curve analysis:there was no diagnostic value of RDW to predict hepatic fibrosis S≥2.The cutoff value of RDW was 13.65% for hepatic fibrosis S=4,with a sensitivity(SE) of 100% and specificity(SP) of 68.2%,positive predictive value(PPV) of 32.26% and negative predictive value(NPV) of 100%,area under receiver operating characteristic curve(AUROC) of 0.844.The was no diagnostic value of MPV to predict hepatic fibrosis S≥2. The cutoff value of MPV was 11.75fl for hepatic fibrosis S=4,with a SE of 80.0% and SP of 70.0%,PPV of 28.6% and NPV of 95.8%,AUROC of 0.760.The cutoff value of RPR was 0.083 for hepatic fibrosis S≥2,with a SE of 68.6% and SP of 80.0%, PPV of 87.5% and NPV of 55.56%, AUROC of 0.778, the cutoff value of RPR was 0.105 for hepatic fibrosis S=4,with a SE of 80.0% and SP of 75.7%,PPV of 33.3% and NPV of 96.1%,AUROC of 0.805.Conclusions:1.RDW、PLT、RPR were laboratory markers to assessment the severity of fibrosis in patients with CHB:with the increase in the severity of hepatic fibrosis, the mean levels of RDW and RPR gradually increased,the mean levels of platelet count gradually decreased.2.RPR was a simple and effective noninvasive methods to predict hepatic fibrosis S≥2 and S=4 in patients with CHB.3.There were no diagnostic value of RDW、MPV in predicting hepatic fibrosis S≥2 in patients with CHB,but they may be noninvasive methods to predict S=4, larger prospective and multicenter studies are needed to validate these findings...