| Objective:To investigate the impact of steatosis on liver stiffness (LS) detected by transient elastography (Fibroscan) in patients with chronic hepatitis B (CHB); To provide some clinical evidence for non-invasive diagnosis of liver fibrosis through analyzing the solely and jointly diagnostic value of the Fibroscan value (LSM) and aspartate aminotransferase-to-platelet ratio index(APRI),FIB-4 in chronic hepatitis B with and without steatosis.Method:1.237 cases of CHB who underwent liver pathology and Fibroscan from January 2010 to May 2013 were retrospectively analysed. Biochemical parameters were collected. LS M in patients of CHB with and without steatosis were compared. LSM in patients of the same stage of liver fibrosis combined with different degrees of steatosis were compared using ANOVA. Cut-off values were obtained by Receiver Operating Characteristic (ROC curve) analysis.2.117 cases of CHB who underwent liver pathology and Fibroscan from June 2012 to May 2013 were retrospectively analysed. Biochemical parameters were collected. Correlation analysis was performed with the Spearman test. The diagnostic value of LSM, APRI, FIB-4 for liver fibrosis of CHB combined with steatosis was compared with the receiver operating characteristic curve (ROC). The areas under the ROC curve (AUC) of LSM alone, or in combination with APRI, FIB-4 for the diagnosis of liver fibrosis of CHB combined with steatosis were compared.Results:1.Steatosis was present in 75 (31.6%) cases, steatosis was absent in 162 (68.4%) cases. In every stage of fibrosis, combined with steatosis has no significant impact on LSM (p>0.05). While in the degree of F2, LSM in patients combined with the steatosis (S2) were higher than those in patients without steatosis (SO) P<0.05) and with mild steatosis (S1) (P<0.05).LS values were 11.28±5.54,8.68±2.95,8.12±2.44KPa, respectively.2.①In group combined with steatosis, LSM,APR1 and FIB-4 were strongly correlated with liver fibrosis stages, with correlation coefficients of 0.717,0.880 and 0.537 (p<0.05). The AUC for LSM were 0.920,0.970 for S3 and S4,while the AUC for APRI and FIB-4 for F3 and F4 were 0.931、0.818 and 0.701、0.970, from the detection results, Fibroscan compared with APRI and FIB-4 is more accurate in detecting significant liver fibrosis. The AUCs of LSM and LSM plus APR1,FIB-4 were 0.871,0.920,0.970and1.000,0.971,1.000,for diagnosis of F2,F3,F4,suggesting that the joint use of LSM and APRI,FIB-4 outperforms LSM alone in the diagnosis of liver fibrosis.②In group without steatosis, LSM and FIB-4 were strongly correlated with liver fibrosis stages, with correlation coefficients of 0.649 and 0.514(p<0.05),while APRI and liver fibrosis stages have no significant correlation(p>0.05). The AUC for LSM were 0.892,0.971 for S3 and S4,while the AUC for APRI and FIB-4 for F3 and F4 were 0.522、0.880 and 0.810、0.892, according to the detection results, Fibroscan compared with APRI and FIB-4 is more accurate in detecting significant liver fibrosis. The AUCs of LSM and LSM plus APR1,FIB-4 were 0.795、0.892、0.971 and 0.890、0.916、 0.989,for diagnosis of F2,F3,F4,suggesting that the joint use of LSM and APRI,FIB-4 outperforms LSM alone in the diagnosis of liver fibrosis.Conclusions:1.LSM which was detected by Fibroscan in patients of CHB combined with steatosis and without steatosis have no significant difference; In patients with fibrosis stage of F2, LSM in those combined with moderate steatosis (S2) were higher than those without steatosis and with mild steatosis.2. Fibroscan has high diagnostic value in detectingt liver fibrosis in patients of CHB combined with and without steatosis.3. Liver fibrosis stages have positive correlation with LSM, APRI and FIB-4, in patients of CHB combined with steatosis.4.Compared with APRI and FIB-4, fibroscan is more accurate when applied to evalue liver fibrosis in patients with chronic liver diseases.5. The diagnostic accuracy increased when Fibroscan combined with APRI and FIB-4 in evaluating degree of liver fibrosis. |
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