| Objective:To investigate the causes of disease among patients with liver disease in the Outpatient Department of Infectious Diseases in First Affiliated Hospital of Nanjing Medical University and the changes in such causes within the past 2 years.To evaluate the diagnostic value of transient elastography(FibroScan)and FibroScan combined with serological markers for liver fibrosis in patients with chronic hepatitis B(CHB).Methods:A retrospective analysis was performed for the clinical data of 1858 patients who were assessed by FibroScan in the Outpatient Department of Infectious Diseases in First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2017.A total of 81 patients with chronic hepatitis B(CHB)undergoing percutaneous liver biopsy were screened.Meanwhile,blood routine tests,liver blood tests and prothrombin time tests were performed.Liver Biopsy as the"gold standard",the diagnostic accuracy of FihroScan,FIB-4,APRI,AAR and GPR for liver fibrosis was analyzed by receiver operating characteristic(ROC)curve and area under the ROC curve(AUC).The performance of liver fibrosis staging between liver biopsy and LSM values were compared by statistical analysis.Results:Of all 1858 patients with liver disease,1471(79.17%)had chronic hepatitis B,143(7.70%)had chronic hepatitis B,85(4.57%)had Non-alcohol fatty liver disease,45(2.42%)had Autoimmune liver diseases,11(0.60%)had drag-induced liver injury,8(0.43%)had Alcoholic liver disease,95(5.11%)still had no clear cause of disease.The proportion of patients with viral hepatitis was 90.92%in 2016 and 80.34%(P<0.05).There were also certain changes in the proportion of patients with liver disease caused by other reasons.CHB,CHC,NAFLD,AILD and unexplained liver injury group had statistically significant difference in sex composition and average age(P<0.05).The LSM values of patients with different etiologies were statistically different(P<0.05).Considered SO as no liver fibrosis group,S1 as mild liver fibrosis group,S2 as moderate liver fibrosis group,and S3 as severe liver fibrosis group,the LSM values of each group was 4.8 ± 1.0 kPa?6.5±2.0 kPa?10.6±4.7 kPa?16.7±5.9 kPa?22.9± 16.8 kPa?respectively(P<0.001).LSM value had a significant direct correlation with liver fibrosis(r=0.790,P<0.001).The AUCs of LSM for predicting liver fibrosis stages ?F2,?F3 and =F4 were 0.906?0.925 ?0.871,respectively,higher than FIB-4,APRI,AAR,GPR.For assessing liver fibrosis,FibroScan has high consistency with liver histopathological staging.When LSM is combined with FIB-4 or AAR,its diagnostic efficiency is further improved.Conclusions:FibroScan is a promising non-invasive method for assessment of liver fibrosis.It has high consistency with liver histopathological staging and it may play an important role in the follow-up and management of these patients.When LSM is combined with FIB-4 or AAR,its diagnostic efficiency is further improved.Objective:The purpose of this retrospective study was to assess the improvement of liver fibrosis during antiviral treatment by serial liver stiffness(LS)measurement using Fibroscan in chronic hepatitis B(CHB)patients.Methods:A total of 259 CHB patients who underwent LS measurement in The First Affiliated Hospital of Nanjing Medical University from January 2015 to June 2018 were enrolled.All patients received nucleos(t)ide analogues and more than 2 times of FS test,and were tested for blood routine,liver blood tests and coagulation function within 1 weeks before and after each FS test,and analyzed the changes of LSM and blood test results during antiviral treatment.Results:The mean time of two measurements before and after antiviral treatment was(10.71 + 6.24)months,and the mean LS value decreased significantly(9.36 + 5.66 vs 6.78 + 3.69;P<0.05).A total of 93 patients had no change in fibrosis stage,and fibrosis stage decreased more than 1 in 153 patients.50 of them had improved from?F3 to ?F2.Fibrosis stage increased in 13 patients,of whom 6 patients progressed from?F2 to ?F3.Of the 259 patients,94 patients received third liver stiffness measurements,of which 53 patients had a lower fibrosis stage than the first,and 29patients did not change the stage of liver fibrosis at three times.The mean LSM values before and after three tests were 10.77 + 7.84,8.41 + 5.60,6.77 + 3.75(F=47.450,P<0.001)respectively.Of the 94 patients,30 patients received 5 tests,with an average LSM value of 13.22 + 6.68,10.35 + 4.81,9.09 + 3.85,8.07 + 3.2,6.95 + 2.49(F=24.199,P<0.001).There was no significant difference in mean LSM between different nucleosides(H=0.851,P>0.05).There was no significant difference in the average LSM value between the two intervals(H=0.744,P>0.05).Conclusions:In CHB patients receiving antiviral treatment,LSM of FibroScan detection showed improvement in liver fibrosis.FS can be used safely for continuous monitoring of liver fibrosis progression or improvement during antiviral therapy. |
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