| Objective:To compare and analyze the FIB-4,GPR,APRI,S index and combined application in the diagnosis of noninvasive fibrosis in chronic hepatitis B(chronic hepatitis B,CHB)in order to provide reference for clinical diagnosis of liver fibrosis.Method:In this study,202 patients with chronic hepatitis B were selected from January 2009 to August 2018 in the Department of hepatobiliary and Pancreatic Medicine of the first Hospital of Jilin University by retrospective analysis.We collected the patients’ data,such as age,sex,alanine aminotransferase(ALT),aspartate aminotransferase(AST),rglutamyltransferase(GGT),platelet(PLT),albumin(ALB)and other cases.Then we calculated the numerical value of FIB-4,GPR,APRI,S index.According to the international Scheuer classification(GS grade),the patients were divided into three groups: significant fibrosis group(≥ S2),extensive group(≥ S3)and cirrhosis group(≥ S4).The clinical features of each group were analyzed,and the correlation with hepatic fibrosis was analyzed.The specificity and sensitivity of noninvasive diagnostic model FIB-4,GPR,APRI,S index and model combination in the diagnosis of hepatic fibrosis in each group were calculated respectively.The ROC curves were drawn.And the data were analyzed and compared with each other by statistical method.Result:1.A total of 202 patients with CHB were included in this study,including 130 males(64.4%)and 72 females(35.6%).The mean age was 41.0 ±10.7 years old.The patients with S0-S4 stage were 32(15.8%),93(46%),28(13.9%),29(14.4%)and 20(9.9%),respectively.2.The results of Spearman correlation analysis showed that the correlation coefficients between age,AST,GGT,platelet,albumin and hepatic fibrosis were 0.139,0.208,0.363,0.265 and 0.195,respectively.There was a positive correlation between age,AST,GGT and hepatic fibrosis.There was a negative correlation between PLT,ALB and hepatic fibrosis.The correlation coefficients between ALT and hepatic fibrosis was 0.087,P > 0.05,and there was no significant difference between them.The correlation coefficient between FIB-4,GPR,APRI,S index and hepatic fibrosis was 0.302,0.399,0.268 and 0.416,respectively,P < 0.0001,and the difference was statistically significant.3.The median of AST,GGT in the group without obvious fibrosis was higher than that in the group without significant fibrosis(P < 0.05),and the difference was statistically significant.The median of albumin and platelet in the significantly fibrotic group was lower than that in the non-significantly fibrotic group(P < 0.05),and the difference was statistically significant.There was a significant difference in the median FIB-4,GPR,APRI,S index between the two groups(P < 0.05).When the FIB-4 cut off value was 1.66,the sensitivity,specificity,positive predictive value and negative predictive value were 0.474,0.816,0.600 and 0.716,respectively.When the GPR cut-off value was 0.25,the sensitivity,specificity and PPV,NPV were 0.711,0.648,0,545,0.784,respectively.when the APRI cut-off value was 0.54,the sensitivity,specificity and PPV,NPV were 0.539,0.736,0.548 and 0.719,respectively.When the S index cut off value was 0.08,the sensitivity,specificity and PPV,NPVwere0.776,0.584,0.533,0.792,0.776,0.584,0.533,0.792,respectiv ely.The area under the curve of FIB-4,GPR,APRI,S index was 0.665(95%CI,0.587-0.744),0.691(95%CI,0.616-0.765),0.641(95%CI,0.564-0.719),0.703(95%CI,0.630-0.777),respe-ctively.The area under the curve of four diagnostic models was compare-d in pairwise.The Z values of FIB-4 and GPR,FIB-4 and APRI,FIB-4 an-d S index,GPR and APRI,GPR and S index were 0.654,0.727,1.002,1.622,1.208,P > 0.05,respectively.The difference was not statistically significant.The Z value of APRI and S index was 2.078(P < 0.05),and the difference was statistically significant(P < 0.05).When FIB-4,GPR,APRI,S index is combined in parallel and series,FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR index and S index are used in parallel connection.The sensitivity and specificity of APRI and S index were(0.848,0.529),(0.758,0.601),(0.882,0.477),(0.867,0.477),(0.935,0.378),(0.897,0.429),respectively.In series,the sensitivity and specificity of FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR and S index,APRI and S index were(0.337,0.935),(0.255,0.951),(0.368,0.337,0.935),(0.255,0.951),(0.368,respectively).0.923),(0.383,0.907),(0.552,0.854),(0.418,0.890),respectively.4.Compared with the progressive fibrosis group,the median albumin and platelet in the progressive fibrosis group were lower than those in the mild fibrosis group(P < 0.05),and the difference was statistically significant.There was a significant difference in the median FIB-4,GPR,APRI,S index between the two groups(P < 0.05).When the FIB-4 cut off value was 1.66,the sensitivity and specificity for the diagnosis of extensive fibrosis were 0.571,0.796,0.467,0.851.The sensitivity and specificity were 0.571,0.796,0.467 and 0.851 respectively.When the GPR cut-off value was 0.27,the sensitivity,specificity and PPV,NPV were 0.857,0.579,0.396,0.926,respectively.When the APRI cut off value was 0.55,the sensitivity,specificity and PPV,NPV were 0.633,0.717,0.411,0.852.The sensitivity,specificity and specificity were 0.633,0.717,0.411 and 0.852 respectively.The sensitivity,specificity and PPV,NPV were 0.857,0.599,0.400 and 0.927,respectively,when the S index cut off value was 0.09,and the sensitivity and specificity were 0.857,0.599,0.400 and 0.927,respectively.The area under the curve of FIB-4,GPR,APRI,S index was 0.698(95%CI,0.608-0.789),0.753(95%CI,0.678-0.828),0.672(95%CI,0.584-0.760),0.765(95%CI,0.691-0.838),respectively.The area under the curve of four diagnostic models was compared in pairwise.The values of FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and S index,APRI and S index were 1.352,0.720,1.708,1.101,2.962,respectively,P > 0.05,and the values of Z were 1.352,0.720,1.708,1.101,2.962,respectively.The difference was not statistically significant.The Z value of GPR and APRI was 2.586(P < 0.05),and the difference was statistically significant(P < 0.05).When FIB-4,GPR,APRI,S index is combined in parallel and series,FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR index and S index are used in parallel connection.The sensitivity and specificity of APRI and S index were(0.930,0.449),(0.843,0.532),(0.895,0.495),(0.910,0.49),(0.940,0.399),(0.865,0.473),respectively.In series,the sensitivity and specificity of FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR and S index,APRI and S index were(0.520,0.899),(0.358,0.927),(0.455,0.914),(0.440,0.886),(0.560,0.866),(0.385,0.903),respectively.5.Compared with the non-cirrhotic group,the median platelet count in the cirrhotic group was lower than that in the non-cirrhotic group(P < 0.05),and the difference was statistically significant.There was a significant difference in the median FIB-4,GPR,S index between the two groups(P < 0.05),but there was no significant difference in APRI between the two groups(P > 0.05).When the cut-off value of FIB-4 was 1.66,the sensitivity,specificity and PPV,NPV were 0.650,0.746,0.217,0.950,respectively.When the cut-off value of GPR was 0.33,the sensitivity and specificity of PPV,NPV were 0.800,0.602,0.178 and 0.964,respectively.When the cut-off value of APRI was 0.65,the sensitivity,specificity and PPV,NPV were 0.550,0.713,0.169 and 0.934,respectively.When the cut-off value of S index is 0.13,the sensitivity,specificity and PPV,NPV are 0.7,0.663,0.184,0.952.The area under curve of FIB-4,GPR,APRI,S index was 0.677(95%CI,0.536-0.817),0.706(95%CI,0.593-0.820)and 0.630(95%CI,0.498-0.763),0.713(95%CI,0.601-0.826),respectively.The area under the curve of four diagnostic models was compared in pairwise.The values of FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR and S index,APRI and S index were 0.553,1.248,0.777,1.565,0.349,1.853,0.553,1.248,0.777,1.565,0.349,1.853,respectively.There was no significant difference between the two groups(P > 0.05).When FIB-4,GPR,APRI,S index is combined in parallel and series,FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR index and S index are used in parallel connection.The sensitivity and specificity of APRI and S index were FIB-4 and GPR(0.930,0.449),(0.8433,0.532),(0.895,0.495),(0.910,0.49),(0.940,0.399),(0.865,0.473),respectively.In series,the sensitivity and specificity of FIB-4 and GPR,FIB-4 and APRI,FIB-4 and S index,GPR and APRI,GPR and S index,APRI and S index were(0.520,0.899),(0.358,0.927),(0.455,0.914),(0.440,0.886),(0.560,0.866),(0.385,0.903),respectively.Conclusion:1.For the diagnosis of liver fibrosis in chronic hepatitis B,when FIB-4,APRI,GPR and S index were used alone,the sensitivity of S index in the diagnosis of significant fibrosis(S ≥ 2)was better.The sensitivity of S index and GPR in the diagnosis of progressive fibrosis(S ≥ 3)is better,and negative predictive value is the greatest.GPR has a good sensitivity in the diagnosis of liver cirrhosis(S ≥ 4).2.The sensitivity of GPR and S index in parallel was better in the diagnosis of liver fibrosis in each stage,and it was better than that in the diagnosis alone.APRI and FIB-4 were more specific in series. |
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