The Value Of APRI, GPRI And FIB-4 In The Diagnosis Of Liver Fibrosis

BackgroundLiver fibrosis is the abnormal formation and degradation of various extracellular matrix in the liver during the process of inflammation and necrosis of the liver cells,resulting in the abnormal proliferation of fibrous connective tissue in liver.Finally,it develops to different degrees of liver fibrosis,cirrhosis and even liver cancer.In the course of the above diseases,if we actively remove the damage factors,we can prevent or delay the process of the disease.Therefore,early diagnosis and correct assessment of the degree of liver fibrosis are of great clinical significance.At present,the gold standard for diagnosing liver fibrosis is biopsy.However,because of its invasive examination and the risk of multiple complications and poor dependence of patients,it is not conducive to clinical application.Therefore,it is imminent to find a series of economic,practical and easy to accept diagnostic methods.In recent years,domestic and foreign scholars have reported some noninvasive serum mathematical models which have high diagnostic value for the degree of liver fibrosis independently or jointly,such as APRI,FIB-4,GPRI.But in different studies,the diagnosis efficiency,the sensitivity specificity and the optimal cut-off of APRI FIB-4 GPRI for the diagnosis of different degrees of liver fibrosis is not the same.And most noninvasive serological models for the diagnosis of liver fibrosis were established and verified in patients with alcoholic hepatiti and chronic hepatitis C,so if these models are suitable for patients in China should remains to be further studied.ObjectiveThe clinical value of APRI,GPRI,FIB-4 which are separated and combined in the diagnosis of liver fibrosis is discussed with the pathological results of liver tissue as the diagnostic criterion.MethodFrom March 2014 to August 2018,there are 93 cases who had liver biopsy or liver resection with pathological examination of liver tissue were selected from the first hospital of Shanxi Medical University.Calculating the numerical value of APRI,GPRI and FIB-4.According to the clinical symptoms,related laboratory results,i aging findings,pathological results and Scheuer system,the research objects are divided into the following 3 groups:the group of mild hepatic fibrosis(S0-S1)which c ontains 41 cases,the group of liver fibrosis group(S2-S3)which contains 25 cases,the group of liver cirrhosis group(S4)which contains 27 cases.Using Spearman cor relation analysis to evaluate the correlation between the pathological results of liver with APRI,GPRI,FIB-4.And using receiver operating characteristic curve(ROC)to calculate the area under the curve(AUC)to compare the diagnostic efficacy of three models for each group,and determine the optimal cut-off value,Sensitivity and specificity;And using the AUC to evaluate the accuracy of APRI+GPRI+FIB-4,APRI+GPRI,APRI+FIB-4,FIB-4+GPRI to diagnosis liver fibrosis.ResultThere is a good positive correlation between the the pathological results of liver and GPRI,FIB-4,APRI(r=0.599,0.681,0.516,P<0.05);Using the AUC to evaluate th e diagnostic efficacy of APRI,GPRI,FIB-4 on liver fibrosis,the results show that the above three kinds of serological model has better diagnostic efficiency in the group of liver cirrhosis group.In the group of cirrhosis,the AUC were0.810[95%CI(0.719-0.901)]、0.866[95%CI(0.795-0.938)]、0.916[95%CI(0.858-0.973)];APRI+FI B-4 and GPRI+FIB-4 were the most effective in the diagnosis of mild liver fibrosis,the AUC was 0.826[95%CI(0.743-0.909)],0.832[95%CI(0.751-0.913),but the sensitivity and specificity of the diagnosis of liver cirrhosis were the highest,the sensitivity were 0.889,0926,and the sensitivity was 0.712 respectively;While APRI+GPRI and APRI+GPRI+FIB-4 were both hard to liver cirrhosis.The diagnostic efficiency of the group was the highest,the AUC was 0.942[95%CI(0.757-0.920)],0.838[95%CI(0.757-0.920)],and the sensitivity and specificity of the diagnosis of livercirrhosis were the highest,the sensitivity was 0.889,the specificity was 0.788 and0.773 respectively;And APRI+FIB-4,GPRI+FIB-4,APRI+GPRI,APRI+GPRI+FIB-4 for obvious liver fibrosis,the effectiveness of the group diagnosis is equivalent,the AUC is 0.665[95%CI(0.551-0.779)],0.568[95%CI(0.443-0.692)],0.660[95%CI(0.529-0.791)],0.661[95%CI(0.546-0.775)].ConclusionAPRI,GPRI and FIB-4 have high diagnostic efficiency for liver cirrhosis,but the diagnostic efficacy of APRI,GPRI and FIB-4 in different combined forms of early and obvious liver fibrosis can be improved in varying degrees,and the diagnostic efficacy,sensitivity and specificity of the combined diagnosis of liver fibrosis are improved.There is high guiding value for early diagnosis and early treatment.