Meaning And Influential Factors Of Fibroscan Detection In Progression Of Patients With Chronic Hepatitis B Disease

Background and ObjectiveLiver fibrosis is the process of progression to liver cirrhosis in all the chronic liver disease. To grasp the degree of liver fibrosis accurately is important for clinical doctors to judge the disease progression and prognosis and take timely intervention. Degree of hepatic fibrosis is diagnosed by hepatic histopathological examination as the gold standard, but the liver pathological examination is an invasive check and many patients can’t accept it. Other methods such as routine laboratory examination, ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and a variety of biological chemical detections were not satisfactory as for their limited sensitivity and specificity in diagnosis of liver fibrosis. In recent years, a newly-developed special technique called transient elastography wave detection (Fibroscan, FS) becomes a quick, easy, repeatable and non-invasive method for diagnosis of liver fibrosis from abroad. It was reported that FS had good diagnostic effect in diagnosis of liver fibrosis and cirrhosis caused by alcoholic hepatitis and chronic viral hepatitis C. And now it was being applied for early diagnosis of liver fibrosis caused by chronic hepatitis B. This study retrospectively analyzed FS detection in660shandong cadastral hospitalized cases with chronic hepatitis B infection, evaluated its efficacy for judgement of the disease progression and determined its influencial factors in diagnosis of liver fibrosis caused by chronic hepatitis B.MethodsThe clinical data were collected from660cases with chronic hepatitis B who were hospitalized in Jinan infectious disease hospital and with FS detection received.And among them,96cases had liver biopsy. A variety of clinical indicators were grouped by their levels, and the differences of FS readings among different levels of clinical indicators were compared respectively. In order to evaluate the influence of different clinical indicators for FS value, a liver stiffness influencial factor model was constructed by multiple linear regression analysis with FS value as the dependent variable. According to the liver pathological fibrosis stage grouping, the receiver-operating characteristic curve (ROC) of FS value was drawn and the area under the curve (AUC) was caculated. FS value in diagnosis of specific degree of hepatic fibrosis was determined with liver biopsy results as the gold standard and its sensitivity was calculated. Statistical software SPSS18.0was used for data analysis, quantity data were expressed by (x±s) and t test or analysis of variance was adopted in the mean comparison.Results1. Patients’age, gender, inner diameter of portal vein, thickness of spleen, ALT, ALB, TBIL, PTA and PLT level were all associated with liver stiffness value and the difference among different levels of clinical indicators had statistical significance (P values<0.05). FS value was higher in male, age>50years’ old, the inner diameter of portal vein>1.3cm, thickness of spleen>4cm, ALT>120u/ml, TBIL>85.5umol/l, ALB<32g/l, PTA<60%and PLT<100×109/1.FS value in different state of HBeAg and HBV DNA level had no statistical difference (P>0.05).2. With FS values as the dependent variables and clinical indicators as independent variables, multiple linear stepwise regression analysis was carried out. The results showed that ALT, PTA, ALB, thickness of the spleen, diameter of portal vein, PLT and TBIL level were related with liver stiffness value and their influencial power to FS value according to standard regression coefficient absolute value gradually decreased in order.3. The fibrosis in all96cases was staged according to "the criterion for prevention and treatment of viral hepatitis B in2000’s edition". There were18cases with mild liver fibrosis (S1),39cases with moderate liver fibrosis (S2),12cases with severe liver fibrosis (S3) and27cases with early liver cirrhosis (S4). FS values’differences among different fibrosis stages had a significant statistical significance (F=34.581, P <0.001).4. The ROC of Fibroscan for mild, moderate, severe liver fibrosis and early cirrhosis were0.724(95%CI:0.650-0.797),0.832(95%CI:0.789-0.876),0.836(95%CI:0.790-0.882) and0.790(95%CI:0.739-0.856). The sensitivity of FS for diagnosis of fibrosis stages above were75.0%,73.8%,83.3%and75.0%respectively, and the specificity were69.9%,87.2%,66.7%and77.3%respectively.5. The maximum sum of sensitivity and specificity on the ROC curve was selected for boundary value (cut-off value) and the cut-off values of FS for diagnosis of mild, moderate, severe liver fibrosis and early cirrhosis were9.8KPa,10.5KPa,12.3KPa and14.8KPa respectively.Conclusions1. FS value has significantly positive correlation with the severity of liver fibrosis, the higher the value of FS, the heavier of the degree of liver fibrosis.2. Fibroscan was valuable for diagnosis of liver fibrosis in different stages and was able to distinguish different degree of fibrosis in patients with chronic hepatitis B accurately. It had the highest sensitivity for diagnosis of severe fibrosis (S3) and the highest specificity for diagnosis of moderate fibrosis (S2).3. FS value can be affected by age, sex and liver inflammation factors.