The Correlation Between Clinical Indexes And The Degree Of Liver Fibrosis In Patients With CHB And The Diagnostic Value Of GPR For Liver Fibrosis

ObjectivesThe aim of this study is to investigate the correlation between clinical indexes and the degree of liver fibrosis in patients with chronic hepatitis B (CHB),and assess the diagnostic value of GPR for significant fibrosis(?S2) and early cirrhosis(=S4) in patients with CHB.MethodsA total of 100 cases CHB patients who underwent liver biopsies at department of gastroenterology,the Second Hospital Afiliated to Kunming Medical University,between January 2012 and Augest 2016,were retrospectively screened.All the patients have complete data. Liver histopathological examination rosults,white blood cell (WBC) , red blood cell (RBC) , platelet (PLT) , prothrombin time(PT) , alanine aminotransferase (ALT),aspartate aminotransferase (AST),albumin (ALB) , alkaline phosphatase (ALP),gamma glutamyl transpeptidase(GGT), cholinesterase (CHE) , total biliary acid (TBA) , total bilirubin (TBIL),direct bilirubin (DBIL),cholesterol (CHOL),prothrombin time (PT),the HBV serological markers,HBV-DNA were recorded.All the hematological parameters were within one week before liver biopsy.These patients were divided into three groups according to the stage of liver fibrosis:no significant fibrosis(S0-S1),significant fibrosis(S2-S3),early cirrhosis(S4),explore the correlation between serologic markers and liver fibrosis.Logistic regression analysis was used to identify independent predictors of significant liver fibrosis.Assess the diagnostic performance of GPR,APRI,and FIB-4 for significant fibrosis and early cirrhosis by the receiver operating characteristic(ROC) curves,and compared the diagnostic value of the three models.Results1.With the increase in the severity of liver fibrosis,WBC,RBC,PLT,ALB,CHE gradually decreased,and AGE,PT,ALT,AST,ALP,GGT,TBA gradually increased.The differences was statistically significant(P< 0.05).2.Comparison between groups: Significant differences were seen in AGE,WBC,RBC,and PLT among the three groups.There was no statistical difference in ALB,ALP,CHE,TBA,PT,ALT,AST,rGT,DB between S0-S1 and S2-S3 groups.3.In logistic regression analysis,PLT and CHE were the independent predictors for significant liver fibrosis in CHB.4.The AUROC of GPR for significant fibrosis(?S2) was 0.76, when the cut-off value was 0.31,the sensitivity was 77.6%,specificity was 66.7%,positive predictive value was 69.1 %,negative predictive value was 75.6%,and accuracy was 72%;The AUROC of GPR for early cirrhosis(=S4) was 0.76, when the cut-off value was 1.03,the sensitivity was 81.2%,specificity was 80.0%,positive predictive value was 95.8%,negative predictive value was 42.9%,and accuracy was 81%.The diagnostic value of GPR for significant fibrosis and cirrhosis was comparable to APRI and FIB-4.ConclusionAGE,WBC,RBC,PLT,PT,ALT,AST,ALB,ALP,CHE,TBA,GGT,DB can be used as auxiliary indicators for monitoring the process of liver fibrosis in CHB;PLT and CHE are independent predictors of significant liver fibrosis, we should be alert to cirrhosis when PLT is below the normal range;GPR is an effective and simple model for evaluating liver fibrosis and early cirrhosis in CHB patients,but it is not superior to APRI and FIB-4.