Diagnostic Value Of Serum Vitamin D,APRI And FIB-4 In Hepatic Fibrosis Of Chronic Hepatitis B

Objective:To investigate the clinical value of serum vitamin D(Vit D),aspartate aminotransferase to platelet ratio index(APRI)and fibrosis index based on 4 factors(FIB-4)in the diagnosis of hepatic fibrosis(HF)in chronic hepatitis B(CHB).Methods:Using a retrospective research method,a total of 245 patients with chronic hepatitis B who underwent liver biopsy in the Department of Infectious Diseases,Affiliated Hospital of Guizhou Medical University from January 2020 to December2021 were selected as the research objects.According to the results of liver biopsy,the stages of liver fibrosis(S)were divided into three groups: non-fibrosis group(S0)(n= 60),mild fibrosis group(S1)(n = 105)and significant fibrosis group(S2-4)(n =80).The biochemical indexes such as serum vitamin D level,platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and general data(sex,age,etc.)were collected,and the specific values of APRI and FIB-4 were calculated by the mathematical formula of non-invasive serum diagnostic model.The data were analyzed and processed by SPSS25.0 statistical software.The measurement data were expressed as mean ±standard deviation((?)±S),single factor analysis of variance(ANOVA)was used for comparison between groups.Spearman correlation coefficient was used to analyze the correlation between serological indexes,serological diagnostic model and the degree of fibrosis.The receiver operating characteristic curve(ROC)of vitamin D,APRI and FIB-4 in the diagnosis of significant fibrosis of chronic hepatitis B(S≥2)was drawn,and the area under the curve of ROC(AUROC)was calculated.The value of AUROC in the diagnosis of significant fibrosis of chronic hepatitis B was compared by Z test.The ROC curve was analyzed by Med Calc statistical software,and the diagnostic critical value,sensitivity and specificity of each index were obtained.The difference was statistically significant(P<0.05).Results:1.There was no significant difference in age and ALT among the three groups(P>0.05).Compared with S0 group,AST,APRI,FIB-4 increased and vitamin D,PLT decreased in S1 group,but there was no significant difference between the two groups(P>0.05);while AST,APRI,FIB-4 increased and vitamin D,PLT decreased in S2-4 group,and there was significant difference between the two groups(P <0.05).Compared with S1 group,APRI and FIB-4 increased,vitamin D and PLT decreased in S2-4 group,and there was significant difference between the two groups(P < 0.05),but there was no significant difference in AST between the two groups(P>0.05).2.The results of Spearman correlation analysis showed that the correlation coefficients of serological indexes ALT,AST,PLT and vitamin D were 0.214,0.232,-0.310 and-0.414 respectively,indicating that ALT and AST were positively correlated with the degree of fibrosis,while PLT and vitamin D were negatively correlated with the degree of fibrosis.The correlation coefficients of serological diagnosis model APRI and FIB-4 were 0.357 and 0.261,respectively.APRI and FIB-4 were positively correlated with the degree of liver fibrosis.3.Vitamin D,APRI and FIB-4 alone had certain value in the diagnosis of significant fibrosis in chronic hepatitis B(AUROC = 0.755,0.720 and 0.661 respectively,P< 0.05.When the cut-off value of vitamin D was 26.80ng/ml,the sensitivity and specificity of diagnosing significant liver fibrosis were 0.725 and0.733 respectively.When the cutoff value of APRI was 0.36,the sensitivity and specificity for the diagnosis of significant hepatic fibrosis were 0.713 and 0.655,respectively.When the cutoff value of FIB-4 was 1.01,the sensitivity and specificity for the diagnosis of significant hepatic fibrosis were 0.725 and 0.558,respectively.The area under the curve of the combination of the three non-invasive diagnostic methods was 0.801,and the sensitivity and specificity were 0.725 and 0.752,respectively.Conclusions:Serum vitamin D,APRI and FIB-4 have certain value in the diagnosis of significant liver fibrosis in chronic hepatitis B,and the efficacy of the combination of the three in the diagnosis of significant liver fibrosis in chronic hepatitis B is better than any single serological index.