The Evaluation Of Liver Transient Elastography And Multi-parameters Model On Chronic Hepatitis B With Hepatic Fibrosis In Children

Objective To evaluate the diagnostic value of the application of liver transient elastography and multi-parameters models to chronic hepatitis B(CHB)with different degrees of hepatic fibrosis in ChildrenMethods A retrospective study was conducted on 148 CHB patients admitted to the hospital from January 1,2015 to December 31,2018.The serum HBs Ag,HBV-DNA,AST / ALT ratio,LSM measured by transient elastography,AST / PLT ratio(APRI),FIB-4 index based on AST,ALT,PLT and age and general data of patients were collected.The patients were divided into two groups by three ways: no hepatic fibrosis group(F0)and hepatic fibrosis group(F ≥ 1),no obvious hepatic fibrosis group(F < 2)and obvious hepatic fibrosis group(F ≥ 2).Non-progressive hepatic fibrosis group(F < 3)and progressive hepatic fibrosis group(F ≥ 3).The diagnostic value of each method for hepatic fibrosis in children with CHB was evaluated by statistical analysis.Results(1)the AUC values of LSM,APRI,FIB-4 index and AAR in diagnosing hepatic fibrosis were 0.740,0.701,0.713,0.440,respectively.The optimum critical values were 7.4k Pa,0.65,10.16,0.88.Their corresponding sensitivity were 64.71%,45.83%,41.76%,31.67%,respectively,and the specificity were 77.78%,89.29%,89.29%,89.29%.The AUC values of the different models with the following combinations: LSM and APRI,LSM and FIB-4,LSM,APRI and FIB-4,APRI and FIB-4 were 0.761,0.739,0.765,0.703,respectively.Their corresponding sensitivity values were 94.12%,94.12%,76.47% and 60%,and the specificity values were 55.56%,55.56%,66.67% and 78.57% respectively.There was no significant difference between the AUC of the model with only LSM and the AUC of the model with only APRI in terms of the diagnostic ability of hepatic fibrosis(Z = 0.346,P = 0.182).There was no significant difference between the AUC of the model with only LSM and the AUC of the model with LSM,APRI and FIB-4 in terms of the diagnostic ability of hepatic fibrosis(Z = 0.183,P = 0.214).(2)the AUC values of LSM,APRI,FIB-4 index and AAR in diagnosing liver fibrosis were 0.849,0.701,0.662 and 0.458,respectively.The optimum critical values were 9.4 k Pa,1.18,15.07,0.96.Their corresponding sensitivity were 63.64%,50%,50%,50%,respectively,and the specificity were 90.62%,83.61%,74.59%,65.57%,respectively.The AUC values of the different models with the following combinations: LSM and APRI,LSM and FIB-4,LSM,APRI and FIB-4,APRI and FIB-4 in diagnosis of liver fibrosis were 0.866,0.844,0.881,0.706 respectively.Their corresponding sensitivity were 90.91%,81.82%,90.91% and 65.38%,respectively.and the specificity values were 71.87%,81.25%,75.00% and 69.67%,respectively.There was a significant difference between the AUC of the model with LSM and the AUC of the model with APRI(Z = 1.651,P=0.024),but there was no significant difference between the AUC of the model with LSM the AUC of the model with APRI,FIB-4 and LSM in terms of the diagnostic ability of hepatic fibrosis(Z = 0.345,P = 0.183).(3)the AUC of LSM,APRI,FIB-4 index and AAR were 0.963,0.813,0.783,0.573,respectively.The optimum critical values were 11.2 k Pa,3.30,1.68,23.36.Their corresponding sensitivity were 66.67%,42.86%,57.14%,42.86%,respectively,and the specificity were 100%,96.45%,82.27%,76.6%.The AUC values of the different models with the following combinations: LSM and APRI,LSM and FIB-4,LSM,APRI and FIB-4,APRI and FIB-4 in diagnosis of liver fibrosis were 1,0.967,1,0.801,respectively.Their corresponding sensitivity were 100%,100%,100% and 71.43%,respectively.And the specificity was 100%,90%,100% and 82.98%,respectively,The AUC values of the model with LSM in the diagnosis of progressive hepatic fibrosis was significantly higher than that of APRI,(Z = 0.618,P = 0.026).There was no significant difference in the The AUC values of the model with LSM combined with APRI,FIB-4 and LSM in terms of the diagnostic ability of progressive hepatic fibrosis(Z =1.000,P=0.079).Conclusion In terms of the diagnostic accuracy,the application of transient elastography is much better than that of APRI,FIB-4 index in the cases under which CHB child patients with obvious and progressive hepatic fibrosis.Furthermore,the transient elastography also has good performance on the diagnosis of the progress of hepatic fibrosis for children with CHB.