| Hepatitis B virus(HBV) infection is a major worldwide health problem: according to the reports of the World Health Organization(WTO) display, about 20 million people worldwide have been infected with HBV, of which an estimated worldwide 3.5 billion people is called chronic hepatitis B patients(hepatitis B surface antigen positive in 6 months or more patients for chronic infection). Liver fibrosis is the results in the accumulation of extracellular matrix components in the liver, is also an intermediate stage of development of liver cirrhosis, once the occurrence of liver cirrhosis patients with severe, irreversible and poor prognosis, and changes in early stage of liver fibrosis is a chronic gradual process, but also is a reversible process, so as to reduce the liver cirrhosis, early detection, early treatment, blocking or slowing the fibrosis process is very meaningful.Accurate diagnosis of liver fibrosis is essential for the management of chronic hepatitis B. Liver biopsy is consi-dered a gold standard for staging and staging of fibrosis. However, liver biopsy is invasive and is not suitable for repeated assessment, because it has the potential to cause serious complications and even death. In order to overcome the limitations of liver biopsy, a large number of non invasive evaluation techniques have emerged. This paper mainly focuses on the parameters of serum markers and the instantaneous elastic imaging technology. At first these noninvasive assessment of liver fibrosis was used in patients with chronic hepatitis C and its adaptability, sensitivity, and accuracy were verified. And noninvasive assessment of liver fibrosis in patients with chronic hepatitis B is urgently needed to confirm the clinical value.Objective:Research by color Doppler ultrasound guided needle biopsy of the liver(liver biopsy and LB) with two-dimensional ultrasonography and transient elastography(FibroScan) and serum mark parameters, Apri and FIB-4 the four no invasive examination methods were compared.On liver fibrosis were relatively favorable outlook and quantitative assessment.Analysis of the three kinds of non-invasive methods of clinical value.Methods :326 cases of patients with chronic hepatitis B were treated with GE E9 ultrasound guided liver biopsy and biopsy specimens for pathological sections, the pathological results were recorded. Over the same period of FibroScan were recorded the detected liver hardness values, while recording alt, with the detection of liver in aspartate aminotransferase, platelet index, FIB-4 value according to the formula APRI, and in patients with two-dimensional ultrasonography. Results were recorded by liver biopsy as the gold standard, draw FS, APRI index, FIB-4 index and receiver operating characteristic curves to calculate the area under the curve(AUC), evaluation of these noninvasive method for chronic liver hepatitis practical clinical value in the diagnosis of hepatic fibrosis staging. Analysis of FibroScan, APRI, FIB-4 and the degree of liver fibrosis and its correlation with FibroScan, evaluation of two models to separate joint And the clinical value of the three methods in the diagnosis of liver fibrosis.Results:326 cases were successfully treated, and there was no complication. In 230 cases, including S0-S1 S2, S3, S4 were 52,24,20 cases. With the rising level of hepatic fibrosis, as measured by FibroScan, APRI, FIB-4 is an upward trend, B-ultrasound, FibroScan, APBI, FIB-4 of hepatic fibrosis in patients with chronic hepatitis B with the staging of liver fibrosis staging is consistent, the Kappa values were respectively 0.489,0.514,0.303,0.372, P <0.001. four between the noninvasive diagnosis and liver biopsy showed good correlation(correlation coefficient r were 0.597,0.642,0.290,0.372, P <0.001).FibroScan and FIB-4, APRI in the diagnosis of liver fibrosis obvious fibrosis group(S = 2) area under the ROC curve(AUC) were 0.908,0.857,0.840, early cirrhosis group(S4) and area under ROC curve(AUC) respectively, the diagnostic accuracy of 0.956,0.922,0.876.FibroScan was higher than that of APRI, FIB-4.APRI, F Combined use of ib4 and FibroScan, FibroScan Apri, FibroScan fib4, FibroScan Apri fib4 in S<2 no significant fibrosis group the ROC curve(AUC) respectively0.801,0.826, 0.832, fibrosis group(s is more than or equal to 2) AUC values were 0.901, 0.909, 0.917, early cirrhosis group(S4) the AUC values were increased to 0.928,0.946,0.967, diagnostic accuracy is significantly improved.Conclusions:Non invasive examination method can be of a part of patients whether biopsy is necessary for early screening, can avoid patients unnecessary injury and pain.FibroScan and FIB-4 and Apri index for chronic HBV infection fibrosis of early hepatic cirrhosis(S4) diagnosis has a high clinical value. No invasive diagnostic methods are used in combination can improve the diagnostic efficiency. |
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