Research On The Relationship And Application Between Platelet And Liver Injury In Patients With Chronic Hepatitis B Virus Infection

AIM: To identify association between platelet count and degree of liver function impairment and the relationship between platelet count to splenic thickness(PC/ST)ratio and clinically significant portal hypertension(CSPH)in patients with chronic hepatitis B virus infection.METHODS: We enrolled 1597 patients with chronic HBV infection from the first hospital of Lanzhou University between June 2016 and August 2017,and 941 patients were included.355 patients were diagnosed as CSPH,of which 175 patients were accompanied with gastroesophageal varices(GEV)performed by undergoing endoscopy,103 patients with red signs.Among above patients,53 patients had undergone liver biopsy.According to the METAVIR scoring system,pathological stage ?F3 and F4 were defined as significant fibrosis and cirrhosis respectively.Correlation analysis verified the relationship between platelet count and liver fibrosis and the association between PC/ST ratio and CSPH.Finally,the multivariate logistic regression analysis and the receiver-operator curves analysis were used to evaluate the performance of platelet count and PC/ST ratio.RESULTS: Compared to HBV-infection patients with CTP-A class,platelet count with CTP-B/C class was lower(P<0.001).Similarly,in patients with normal alanine aminotransferase(ALT)levels,platelet count was statistically significant between CTP-B/C set and CTP-A set(P<0.001).Correlation analysis showed that platelet count was inversely correlated with the CTP score(r=-0.420,P < 0.001).Logistic regression analysis identified that platelet count was independently associated with CTP-B/C(odds ratio[OR],1.025;P=0.009).ROC analysis showed the area under curve(AUC)of platelet count to distinguish CTP-B/C class were 0.712 and 0.791 respectively in patients with chronic HBV infection and normal ALT levels.In addition,compared to patients with chronic hepatitis B,patients with cirrhosis also had lower platelet count(P<0.001).AUC of platelet count to distinguish cirrhosis was 0.927.In patients undergone liver biopsy,platelet count in patients with F4 was lower compared to patients with ?F3(P=0.013),and platelet count was inversely correlated with the pathological stage(r=-0.295,P=0.032).Logistic regression analysis showed platelet count was independently associated with cirrhosis(OR,0.978;P=0.026).The AUC of platelet count to distinguish cirrhosis was 0.761.Furhermore,The PC/ST ratio was significantly lower in patients of chronic HBV infection with CSPH compared to patients without CSPH(1.25vs3.12,P<0.001).Correlation analysis showed PC/ST ratio inversely correlated with splenic thickness and portal vein diameter.Logistic regression identified that PC/ST ratio was independently associated with the presence of CSPH(odds ratio[OR],10.723;P<0.001).ROC analysis showed the area under curve(AUC)of PC/ST ratio was 0.797 to distinguish the CSPH.Additionally,we found platelet count was significantly lower in patients with CSPH and GEV compared to patients without GEV(64.10vs76.30,P=0.036).Besides,for patients with red signs,PC/ST ratio was lower compared to patients without red signs(1.05vs1.46,P=0.010).AUC of PC/ST ratio to distinguish the red signs was 0.667.CONCLUSION: Platelet count is not only close correlation with the degree of liver function,but also can assess severity of liver fibrosis in patients with chronic HBV infection.Additionally,PC/ST ratio,an easily obtained non-invasive parameter,is independently associated with CSPH and red sign,can be used to distinguish the presence of CSPH and red sign in patients with chronic HBV infection.