| Objective:To testify the diagnostic value of Fibroscan for liver fibrosis in patients with CHB by comparing with common biochemistry markers. Learn about the influence factors of Fibroscan to provide clinical evidence for its extensive use.Methods:171 cases of chronic hepatitis B were enrolled. All of them were diagnosed according to prevention and control guidelines of chronic hepatitis B formulated in 2005.Blood tests and examines:1.serum markers:hyaluronieacid(HA), lamnin (LN), typeⅣof collagen (CⅣ) and typeⅢprecollagen (PCⅢ); Platelet (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), y-glutamyl GGT (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid (TBA), albumin (ALB), cholinesterase (CHE), prothrombin time (PT), white blood cell (WBC) 2.Liver biopsy 3.Fibroscan.Statistical analysis:Statistical analysis was performed by SPSS software version 16.0. Continuous variables were expressed as mean±SD. T test and one-way AN OVA were used for means comparision. Application of Spearman's correlation and partial correlation analysis correlation. Three different endpoints were studied according to liver fibrosis stage, namely significant fibrosis (S2 to S4), extensive fibrosis(S3 to S4) and cirrhosis(S4). With liver biopsy as the gold standard, ROC curves were delineated for different endpoints. The area under the ROC curves reflected its diagnostic values. A two-side P value of less than 0.05 was considered statistically significant.Results:The LSMs of each liver fibrosis stage is significantly different, p=0.000. LSM was significantly correlated with liver fibrosis, r=0.663. The area under receiver operating characteristic curves of FS were 0.883(95%CI:0.883～0.934) for S≥2, 0.838(95%CI:0.774～0.903) S≥3,0.791(95%CI:0.696～0.886) for S=4, respectively. Optimal LSM cut-off values were 10.8 kPa for S≥2,13.6 kPa for S≥3, 10.8 kPa for S=4 by maximizing the sum D of sensitivity and specificity.The Spearman's correlation between hepatic fibrosis and serum HA, typeⅢprecollagen and type IV collagen was 0.332,0.476 and 0.319, respectively(P=0.000). The area under receiver operating characteristic curves of HA, Lamnin, type III precollagen and type IV collagen were 0.671,0.594,0.776,0.678 for S≥2,0.676, 0.557,0.707,0.638 for S≥3 and 0.703,0.596,0.651,0.679 for S=4, respectively. Optimal LSM cut-off values were 96.0ug/L,110.5ug/L,103.5ug/L,69.5ug/L for S≥2, 98.5ug/L,112.5ug/L,106.5ug/L,70.5ug/Lfor S≥3,98.5ug/L,128.5ug/L,156.0ug/L, 73.5 ug/L for S=4 by maximizing the sum D of sensitivity and specificity.The Spearman's correlation between hepatic fibrosis and APRI was 0.552 respectively (P=0.000). The area under receiver operating characteristic curves of APRI were 0.842 for S≥2,0.730 for S≥3,0.684 for S=4, respectively. Optimal LSM cut-off values were 1.8 for S≥2,1.85 for S≥3,0.82 for S=4 by maximizing the sum D of sensitivity and specificity.Spearman's correlation analysis showed that LSM value associated with the liver inflammation grade significantly besides liver fibrosis. As the liver inflammatory serum markers, ALT, AST, GGT, ALP, TBIL, DBIL, TBA, ALB, A/G, CHE but liver steatosis and BMI correlated with LSM values. In a partial correlation analysis, controlling liver fibrosis and liver inflammation, ALT, AST, GGT, TBIL, DBIL, TBA, ALB, A/G, PT and PLT etc show less relevant, but still significant. Comparison showed differences between the different ALT levels but the same fibrosis stage. Although ALT levels affect the value of LSM, the liver fibrosis is still the decisive factor.Conclusion:Fibroscan is a reasonable noninvasive tool for the assessment of liver fibrosis, better than common biochemistry markers such as APRI, HA, PCⅢ, LN, C IV. Although LSM also affected by liver inflammation, ALT, AST, GGT, TBIL, DBIL, TBA, ALB, A/G, PT and PLT besides liver fibrosis, the liver fibrosis is still the decisive factor. FS has important guiding significance for the diagnosis and treatment of hepatitis B. |
PDF Full Text Request