Evaluation Of Non-invasive Methods In HBV-infected Patients With Persistently Normal Liver Function

Aim:To validate and compare the performance of APRI, FIB-4 and transient elastography(TE) in chronic HBV patients with persistently normal liver function, and explore a new method to improve the diagnostic accuracy.Method:58 chronic HBV patients with normal liver function who performed liver biopsy during 2010.1 to 2015.12 in First Bethune Hospital of Jilin University were included in this study. Their basic characteristics, serum biomarkers, viral hepatitis markers, TE and liver biopsy results were collected. We evaluated the performance of APRI, FIB-4,TE and paired combinations of TE with each of the serum non-invasive diagnostic algorithm. Having liver biopsy as the “gold standard”, liver fibrosis was staged according to the Scheuer scoring system(Fibrosis stage S2-S4 was termed as significant fibrosis). Diagnosis value was assessed by sensitivity, specificity, positive predict value, negative predict value, diagnostic accuracy and AUROC. Combine each of the serum biomarkers algorithms with TE and evaluate the diagnostic value of the combination.Results:1, The AUROC of APRI, FIB-4 and TE to predict significant fibrosis is 0.696,0.708 and 0.756, respectively. The diagnostic accuracy is 65.5%, 72.4% and 60.3%,respectively.2, When combining APRI or FIB-4 with TE separately, the diagnostic accuracy of the combinations are 77.8% and 85.2%. The combination of FIB-4 and TE has the best results, when they agree, 46.6% of the patients can avoid live biopsy.Conclusion:APRI, FIB-4 and TE have moderate diagnostic accuracy for predicting significant fibrosis in chronic HBV patients with persistently normal liver function. The combination of FIB-4 and TE can improve the performance when compared with each of the non-invasive method alone, nearly half of the patients can avoid liver biopsy.But the combination can't replace liver biopsy completely.