Evaluation And Analysis Of Diagnostic Indexes Of Liver Inflammation And Fibrosis In Patients With Chronic B Virus Infection

Objective: A clear determination of the degree of fibrosis and liver inflammation in patients with chronic B virus infection with normal ALT is the key to evaluating whether to initiate antiviral therapy.In this study,liver puncture examination results were used as the "gold standard" to evaluate the diagnostic value of AAGP,AAG,FIB-4,GPR,transient elasticity imaging(TE),APRI,and other non-invasive diagnostic indicators for patients with liver inflammation and liver fibrosis.Methods: The clinicopathological data of 72 patients with chronic B virus infection with normal ALT who underwent liver puncture in our center from January 2015 to January 2020 were collected.The pathological results of liver puncture were used as the diagnostic "gold standard" to evaluate the diagnostic value of two non-invasive diagnostic indicators,AAGP and AAG,for liver inflammation.The diagnostic value of FIB-4,APRI,GPR,TE these four non-invasive diagnostic indicators for the degree of liver fibrosis,the working curve(ROC)of different indicators was drawn,and the area under the curve(AUROC)sensitivity,specificity,PPV,NPV equivalent.Results: Among 72 patients with HBV infection,liver puncture results confirmed that30.6% of patients had obvious liver inflammation(≥G2),and 22.2% had obvious liver fibrosis(≥S2).The best cut-off value for AAG to judge liver inflammation is 3.5(AUROC =0.693),the sensitivity and specificity are 59.1% and 56%,respectively,while the best cut-off value for AAGP judgment is 4.5(AUROC =0.684),the sensitivity and specificity are respectively They were 68.2% and 52%,and there was no statistically significant difference between the two(P>0.05).After the combination of AAG and AAGP(AUROC=0.711),the sensitivity was 98.2% and the specificity was46%.Among the four indicators for judging the degree of liver fibrosis,GPR has the greatest diagnostic value(AUC=0.812),with sensitivity and specificity of 75% and87.5%,respectively.Next is APRI.The best cut-off value for APRI diagnosis is 0.325(AUROC = 0.726),and its sensitivity and specificity are 58.9% and 81.3%,respectively.FIB-4 has AUROC=0.702,its sensitivity is low(55.4%),and its specificity can reach87.5%.TE has the lowest diagnostic value,and its AUROC is less than 0.7.When combining FIB-4,APRI,and GPR,the sensitivity and specificity of FIB-4 combined with GPR diagnosis ≥ S2 group(AUROC=0.765)were 81.25% and 71.43%;FIB-4combined with APRI diagnosis ≥ S2 group(AUROC=0.748),sensitivity and specificity were 75.0% and 67.86%,respectively;APRI combined with GPR in the diagnosis of ≥S2 group(AUROC = 0.801),sensitivity and specificity were 87.5% and 71.43%,respectively;APRI combined with GPR in the diagnosis of liver The fibrosis ability is the strongest.Conclusion: 1.Diagnosis of liver inflammation in chronic HBV infection with normal ALT: The diagnostic ability is enhanced when two non-invasive diagnostic indicators are used in combination.2.Diagnosis of liver fibrosis caused by chronic HBV infection: When FIB-4,TE,GPR,and APRI are used alone,GPR has the strongest ability to diagnose liver fibrosis.When FIB-4,GPR,and APRI are used in combination,the specificity and sensitivity can be significantly increased,and APRI combined with GPR is the best.