Clinical Study On Predictive Value Of Transient Elastography,alpha-fetoprotein And FIB-4 Index In Hepatitis B-related Hepatocellular Carcinoma

Objective:To study the risk factors of hepatocellular carcinoma(HCC)in patients with hepatic cirrhosis of chronic hepatitis B and to evaluate the predictive value of transient elastography(TE),alpha-fetoprotein(AFP)combined with FIB-4 index for hepatitis B associated HCC.Methods:From January 2015 to January 2016,patients with chronic hepatitis B cirrhosis who visited at our hospital’s clinic or hospitalized were collected.The liver stiffness measurement(LSM)of all patients was measured by instantaneous elastography(Fibrotouch),and the serum liver function,blood routine test,AFP,HBV-DNA,hepatitis B two-and-a-half pairs,liver color Doppler ultrasound and other related examinations were performed.All patients who met the inclusion criteria were followed up regularly.The follow-up time was the time when HCC occurred,and the patients who did not have HCC and died were followed up for 3 years.To compare whether there is statistical difference between the general clinical data of HCC group and non-HCC group;to study the risk factors of HCC in patients with chronic hepatitis B cirrhosis;to compare whether the LSM value,the FIB-4 index and the cumulative incidence of HCC in different cirrhosis staging,different Child-Pugh classification groups were statistically different,and whether there was statistical analysis on the cumulative incidence of HCC in antiviral treatment group and non-antiviral treatment group.Using the receiver operating characteristic curve(ROC)to evaluate the diagnostic efficacy of HCC,FIB-4 index,and AFP in predicting HCC in patients with chronic hepatitis B cirrhosis,and whether the combination of three indicators can improve the diagnostic efficacy of HCC in patients with chronic hepatitis B cirrhosis;The cut-off values of the LSM value,AFP,and serum FIB-4 index were grouped to determine whether there was a statistical difference in the cumulative incidence of HCC between the groups.Results:1.A total of 188 patients were successfully enrolled and followed up for 3 years.The final follow-up was failed in 12 patients and successful follow-up in 176 patients.The median age of the patients was 50 years(27/75 years),of whom 85 were male and 91 female.After 3 years of regular follow-up and observation,18 patients developed HCC.2.Cox univariate regression analysis showed that age,sex,Glutamic acid amine transferase(AST),albumin(ALB),LSM value,FIB-4 index,APRI index,AFP,HBe-Ag,hepatitis B virus surface antigen quantity.Family history of hepatitis B or hepatocellular carcinoma and diabetes history were risk factors for predicting HCC in patients with chronic hepatitis B cirrhosis.Cox multivariate regression analysis showed that age,family history of hepatitis B or hepatocellular carcinoma,positive HBe-Ag,LSM value,FIB-4 index,AFP is an independent risk factor for predicting HCC in patients with chronic hepatitis B cirrhosis.3.The cumulative incidence of HCC in decompensated cirrhosis group was higher than that in compensated cirrhosis group(P < 0.05),and the LSM value and FIB-4 index were higher than those in compensated cirrhosis group(P < 0.01).The LSM value and cumulative incidence of HCC in Child-Pugh grade C patients were higher than those in grade A patients(P < 0.05),and the FIB-4 index was higher than that in grade A patients(P < 0.01).The LSM value and cumulative incidence of HCC in Child-Pugh grade B patients were higher than those in grade A patients(P < 0.05),and the FIB-4 index was higher than that in grade A patients(P < 0.01).The LSM value of grade C patients in Child-Pugh classification was higher than that of grade B patients(P < 0.05),and the FIB-4 index was higher than that of grade B patients(P < 0.01),but the cumulative incidence of HCC in grade C patients was not significantly different from that of grade B patients(P > 0.05).The cumulative incidence of HCC in non-antiviral treatment group was higher than that in antiviral treatment group(P < 0.01).4.When the ROC curve was used to evaluate the LSM value,AFP,and FIB-4 index to predict the diagnostic efficacy of HCC alone,the area under the receiver’s operating characteristic curve(Area under the Curve of ROC,AUC)was 0.880,0.767,0.879,ROC,respectively.The cut-off values of the curves were 31.86 Kpa,20.12 ug/L,and 4.14,respectively,indicating that the LSM value,AFP,and serum FIB-4 index have certain predictive value for the occurrence of HCC,but there is no statistical difference between the three indicators.(p>0.05).When the three indexes were combined to predict the diagnostic efficacy of HCC,the AUC value was 0.9733.Compared with the above three indexes alone,the diagnostic efficiency of predicting the occurrence of HCC in patients with chronic hepatitis B cirrhosis was significantly improved.The difference was statistically significant(p<0.05).5.The patients were divided into LSM≤31.86 Kpa group and LSM>31.86 Kpa group with the cut-off value of LSM value.The results showed that the cumulative incidence of HCC in LSM>31.86 Kpa group was significantly higher than that in LSM≤31.86 Kpa group,and the difference was statistically significant(p<0.05).Patients with AFP cut-off value were divided into AFP≤20.12 ug/L group and AFP>20.12 ug/L group.The results showed that the cumulative incidence of HCC in AFP>20.12 ug/L group was significantly higher than that in AFP≤20.12 ug/L group.The difference was statistically significant(p<0.05).Patients were divided into FIB-4 index≤4.14 group and FIB-4 index>4.14 group with the cut-off value of FIB-4 index.The results showed that the cumulative incidence of HCC in FIB-4 index>4.14 group was significantly higher than FIB-4 index≤4.14 group,the difference was statistically significant(p<0.05).Conclusion:Age,gender,ALB,AST,HBe-Ag,AFP,LSM value,APRI index,FIB-4 index,hepatitis B virus surface antigen quantification,hepatitis B or family history of liver cancer,and diabetes history are all risk factors for the development of liver cancer,including age.Family history of hepatitis B or liver cancer,HBe-Ag,LSM value,FIB-4 index,and AFP are independent risk factors for the development of HCC.LSM value,AFP and FIB-4 index have certain diagnostic efficacy in predicting the occurrence of HCC in patients with chronic hepatitis B cirrhosis,and the combination of these three indicators can significantly improve the diagnostic efficacy in predicting the occurrence of HCC in patients with chronic hepatitis B cirrhosis,which is worthy of clinical application.