| Objective Chronic hepatitis B(CHB)is a high incidence of chronic infectious diseases,and liver fibrosis is an important stage of its development to cirrhosis,the use of effective methods to understand the degree of fibrosis and give effective prevention,intervention Or treatment,the prognosis is of great significance.Liver biopsy and transient elastography diagnosis of liver fibrosis difficult to be widely used in clinical practice,and thus serological diagnostic model has become a hot topic in recent years.The current guidelines recommend two serological diagnostic models: the aspartate aminotransferase-to-platelet ratio index(APRI)and the fiboblastic index(Fib-4),which can be used to diagnose chronic hepatitis Fibrosis.However,foreign studies have found that ?-glutamyl transpeptidase-to-platelet ratio(GPR)is superior to APRI and Fib-4 in the diagnosis of CHB fibrosis.In this study,we compared the efficacy of GPR,APRI and Fib-4 in the diagnosis of liver fibrosis and cirrhosis of liver.The aim of this study was to find a more clinically valuable serological diagnostic model for early,Simple diagnosis of liver fibrosis,to guide clinical treatment,improve patient prognosis.Method In this study,262 CHB patients with complete data from January 2012 to March 2017 were enrolled in this study using a retrospective study.Including age,sex,Alanine aminotransferase(ALT),aspartate transaminase(AST),?-glutamyl transpeptidase(GGT),and platelet(PLT)were recorded in the general data.GPR,APRI,Fib-4 scores were calculated separately.262 patients underwent liver biopsy.The patients were divided into F0-1 and F2-4 according to the degree of Metavir fibrosis.SPSS 24.0 statistical software was used to analyze the data.The K-S test was used to test the distribution of the sample data.According to the characteristics of the distribution of the sample data,the T-test,rank-sum test and chi-square test were used to compare the mean of the two sets of data.The correlation between serologicalparameters,diagnostic models and liver fibrosis at different stages was analyzed using Spearman correlation coefficient.The receiver operator characteristic(ROC)of GPR,APRI and Fib-4 were used to calculate the diagnostic performance of liver fibrosis at each stage and calculate the area under the ROC curve(AUROCs).Three diagnostic models of liver fibrosis were used to diagnose the efficacy of AUROCs compared to the z test.Each set of data selects two truncated values,which are based on the sum of sensitivity and specificity,respectively,to obtain at least 95% specificity.The positive predictive value(PPV)and negative predictive value(NPV)of each truncated value were calculated by using Med Calc 15.6.1 statistical software to analyze the ROC curve.Result Of the 262 patients,there were 167 males and 95 females with a male to female ratio of 63.7% vs 36.3%(P <0.05).The average age of all subjects was 45.79 ± 11.18 years old.The mean age of F0-F1 group was 42.45 ± 10.67 years old.The average age of F2-F4 group was 49.10 ± 10.71 years old.The average age difference between the two groups was 7 years(P <0.05).Indicating that more men than women in clinical CHB patients,and increased degree of fibrosis gradually increased with age.There were significant differences in GGT,PLT and AST between F0-F1 group and significant fibrosis group.,but no significant difference in ALT and HBV-DNA between the two groups.The levels of GPR,APRI and Fib-4 between the two groups were compared.The results showed that there were significant differences between the two groups in the three serological diagnostic models.The correlation between age,serum markers,serological diagnostic models and liver fibrosis was analyzed using the Spearman correlation coefficient.The results showed that age,GGT,AST,PLT and liver fibrosis Spearman correlation coefficient R were 0.322,0.301,0.199,-0.455.There was a positive correlation between age,GGT,ASTwith hepatic fibrosis,and PLT was negatively correlated.The correlation was PLT> age> GGT> AST.The correlation coefficient between ALT and liver fibrosis r = 0.111,P> 0.05,ALT and significant liver fibrosis was no significant correlation.The correlation coefficient between liver fibrosis and GPR was 0.625,and the correlation coefficient with APRI,Fib-4 were 0.355,0.282 respectively(P <0.05).There was a significant positive correlation between the three and fibrosis,and the correlation was GPR> APRI> Fib-4.Three kinds of serological diagnostic models were used to diagnose AUROCs of liver fibrosis at different stages,and the calculated AUROCs were compared in two pairs.The results were analyzed by Z test.The AUROCs of GPR,APRI,and Fib-4 diagnosised Significant hepatic fibrosis were 0.818,0.694,0.696 respectively.The AUROCs of the three diagnostic models showed that the GPR compared with APRI and Fib-4,the Z values were 4.029,4.078,P <0.05.But the Z values were 0.096,compared with APRI and Fib-4,P> 0.05.Indicating that the value of GPR much higher than APRI and Fib-4 at the diagnosis of significant hepatic fibrosis.But the value of APRI and Fib-4 were no significant difference.The AUROCs of GPR,APRI,and Fib-4 diagnosised progressive hepatic fibrosis were 0.864,0.766,0.770 respectively.The AUROCs of the three diagnostic models showed that the GPR compared with APRI and Fib-4,the Z values were 2.603,2.448,P <0.05.But the Z values were 0.879,compared with APRI and Fib-4,P> 0.05.Indicating that the value of GPR much higher than APRI and Fib-4 at the diagnosis of cirrhosis.The AUROCs of GPR,APRI,and Fib-4 diagnosised cirrhosis were 0.864,0.766,0.770 respectively.The AUROCs of the three diagnostic models showed that the GPR compared with APRI and Fib-4,the Z values were 2.603,2.448,P <0.05.But the Z values were 0.879,compared with APRI and Fib-4,P> 0.05.Indicating that the value of GPR much higher than APRI and Fib-4 at the diagnosis of cirrhosis.The results showed that the AUROCs of GPR in liver fibrosis were higher than those in APRI and Fib-4.Through the analysis of ROC curve,select the sensitivity and specificity of the maximum for the diagnosis of low cut-off value.The low cut-off value of GPR to diagnosised significant hepatic fibrosis was 0.99,and the sensitivity and specificity were 77.1%,the PPV and NPV were 77.1%.APRI = 0.64,the sensitivity was 71.76%,the specificity was 64.12%,the PPV and NPV were 66.7%,69.4% respectively.Fib-4 = 1.80,the sensitivity and specificity were 67.94%,68.70%,PPV and NPV were 68.5% and 68.2% respectively.The low cut-off value of GPR to diagnosised progressive hepatic fibrosis was 1.04,and The sensitivity and specificity were 96.36% and 64.25%,respectively.The PPV and NPV were 41.7% and 98.5% respectively.APRI = 0.65,the sensitivity was 89.09%,the specificity was 56.52%,PPV and NPV were 35.3% and 95.1% respectively.Fib-4 = 1.98,sensitivity and specificity were 81.82%,64.73%,PPV and NPV were 38.1% and 93.1%,respectively.The low cut-off value of GPR to diagnosised cirrhosis was 1.06,and The sensitivity and specificitywere 96.55% and 57.94%,and the PPV and NPV were 22.2% and 99.3% respectively.APRI = 0.72,the sensitivity was 82.76% and the specificity was 59.23 %,PPV and NPV were 20.2%,96.5%,respectively.Fib-4 = 1.85,sensitivity and specificity were 82.76%,55.79%,PPV and NPV were 18.9% and 96.3% respectively.It was found that the accuracy of GPR was significantly higher than that of APRI and Fib-4 in the various stages of liver fibrosis.By optimizing the specificity of more than 95% get a high cut-off value for diagnostics.The high cut-off value of GPR to diagnosised significant hepatic fibrosis was 2.49,and The sensitivity and specificity were 35.11%,95.42%,PPV and NPV were 88.5% and 59.5% respectively.APRI = 2.64,the sensitivity and specificity were 14.50%,95.42%,PPV and NPV were 78.6%,53.4% respectively.Fib-4 = 5.16,the sensitivity and specificity were 16.79%,95.42%,PPV and NPV were 76.0% and 52.7% respectively.The high cut-off value of GPR to diagnosised progressive hepatic fibrosis was 3.69,and the sensitivity and specificity were 41.82% and 95.17%,respectively.The PPV and NPV were 69.7% and 86.0% respectively.APRI = 3.04,the sensitivity was 21.82%,the specificity was 95.17%,PPV and NPV were 54.5% and 82.1% respectively.Fib-4 = 6.58,sensitivity and specificity were 12.73%,96.14%,PPV and NPV were 18.9% and 96.3%,respectively.The high cut-off value of GPR to diagnosised cirrhosis was 6.77,and The sensitivity and specificity were 24.14% and 99.14%,and the PPV and NPV were 77.8% and 91.3% respectively.APRI = 4.74,the sensitivity was 13.79% and the specificity was 96.57%,PPV and NPV were 33.3%,90.0%,respectively.Fib-4=12.87,sensitivity and specificity were 3.45%,98.71%,PPV and NPV were 25.0% and 89.1% respectively.It can be seen from the high cut-off value of GPR diagnosis in various stages of liver fibrosis is higher than APRI and Fib-4.Conclusion 1.Age,GGT,AST,PLT were independent risk factors for fibrosis of chronic hepatitis B virus.With the increase of age,GGT and AST increased,PLT decreased,the degree of fibrosis gradually increased.2.The diagnostic value of GPR in different stages of hepatitis B fibrosis was higher than that of APRI and Fib-4,but there was no significant difference between APRI and Fib-4.3.The two different cut-off values of GPR were more accurate than APRI andFib-4 in the diagnosis of hepatitis B fibrosis.Different diagnostic cut-off values could be selected according to the diagnosis and treatment purposes. |
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