Diagnostic Value And Influencing Factors Of FibroTouch In Chronic Hepatitis B Patients With Liver Fibrosis

Background:Chronic hepatitis B virus (HBV) infection is a global epidemic of infectious diseases, And our country is the high incidence of chronic hepatitis B in the country. According to WHO reported in 2015, Approximately 650 thousand people die each year from HBV infection due to liver failure, cirrhosis and hepatocellular carcinoma (HCC), the global cirrhosis and HCC patients, the proportion of HBV infection were 30% and 45%. The proportion of HBV infection were 60% and 80%., respectively, In patients with cirrhosis and HCC in China. Chronic HBV infection has a chronic progressive development, "chronic hepatitis-liver fibrosis-cirrhosis-HCC" is the general process of its progress. If you can not timely and effective intervention, will gradually to the development of liver cancer. Previous studies have found that the treatment of liver fibrosis and early cirrhosis in a timely and effective intervention, can control the disease progression and reverse, Therefore, early diagnosis and correct assessment of the degree of liver fibrosis For understanding the extent of liver disease progression, determine the degree of treatment and follow-up efficacy are of great value.The most reliable diagnosis of liver fibrosis is still dependent on liver biopsy. But because of its invasive, sampling error, there are complications and not easy to repeat and other factors limit its clinical application. So we need to find an accurate, reliable and reproducible method for the evaluation of liver fibrosis. Ultrasonographic elastography has demonstrated its unique advantages in the diagnosis and evaluation of liver fibrosis in recent years. The ultrasonographic elastography includes Transient elastognaphy, Acoustic radiation force impulse (ARFI), Real-time Tissue Elastograph (RTE). Among them, Transient elastognaphy mainly includes FibroScan and FibroTouch, FibroScan was developed by the French Echosens company in 2002, fibrosis scanner for determination of liver stiffness. At present, there are many researches about FibroScan, As a non-invasive examination method, it has been widely used in the evaluation of liver fibrosis, and has been incorporated into a number of domestic and international guidelines for the prevention and treatment of chronic hepatitis B. FibroTouch is a diagnostic instrument for the diagnosis of liver fibrosis in China, It combines Transient elastognaphy and two-dimensional ultrasound, It is by the Chinese Tsinghua University and Kell Hayes company in R & D. FibroTouch in the elastic imaging at the same time increase the image guided positioning function, And the XL probe is used, So as to improve the accuracy of detection, the success rate and efficiency, more in line with the clinical needs.In this study, chronic hepatitis B patients as the research object, liver biopsy pathological results as the gold standard, to evaluate the role of FibroTouch in the staging of liver fibrosis in patients with hepatitis B.Objective:The value of FibroTouch in the diagnosis of liver fibrosis in chronic hepatitis B was assessed by comparing with ARFI and serological markers, And to understand the influence factors of liver stiffness measurement (LSM), and provide clinical basis for the wide application of FibroTouch.Methods:A retrospective analysis method was used,145 cases of chronic hepatitis B virus infection were collected from July 2014 to November 2015. FibroTouch technique was used to detect liver stiffness (LSM value), and the shear wave velocity of liver (VTQ) was detected by ARFI technique. Determination of Alanine aminotransferase(ALT), Aspartate transaminase (AST), total bilirubin(TBil), Prothrombintime(PT), blood platelet(PLT), Liver fiber four (hyalaronic acid (HA),laminin(LN),type Ⅳ collagen(CⅣ),type Ⅲ collagen(PⅢNP)),And calculate the AST/ALT ratio, APRI, FIB-4.Liver biopsy pathology results as the gold standard, the degree of pathological fibrosis stage is divided into S0-S4. Comparison between different indexes in the stage of fibrosis by using single factor analysis of variance, Correlation analysis using Spearman correlation analysis, The parameters of a good correlation to the degree of liver fibrosis, respectively, S≥ 2, S≥ 3. S=4. For different study endpoints, The receiver operating characteristic curve (ROC) analysis was performed in groups, And determine the optimal cut-off value, sensitivity, specificity and areas under the ROC curve of the liver fibrosis stage. And compare the area under the curve (AUC). Liver stiffness (LSM) as the dependent variable, by using multiple linear regression analysis, the influence factors of LSM value was constructed, and the influence of different clinical indexes on LSM value was evaluated.Results:1.The correlation coefficient of FibroTouch and ARFI was 0.705 (P<0.01), Their correlation coefficients with Pathological stage of liver biopsy were 0.735 and 0.711 (mean P<0.01), respectively.2. Between the different stages of liver fibrosis patients, LSM and VTQ value differences were of statistical significance (P< 0.01), and with the increase of the degree of fibrosis, showed a rising trend, further pairwise compared with LSM value and VTQ value in between stage S0 and S1 no statistical significance (P is 0.348, 0.327).3. When the LSM value was more than 11.2kPa and the VTQ value was more than 1.49 m/s, the area under receiver operating characteristic (ROC) was 0.888,0.875 in the diagnosis S≥ 2 stage, There was no significant difference between the two (P =0.671). When the LSM value was more than 11.7kPa and the VTQ value was more than 1.49 m/s, the area under receiver operating characteristic (ROC) was 0.881,0.856 in the diagnosis S≥ 3 stage, There was no significant difference between the two (P =0.410). When the LSM value was more than 15.1kPa and the VTQ value was more than 1.82 m/s, the area under receiver operating characteristic (ROC) was 0.876,0.884 in the diagnosis S=4 stage. There was no significant difference between the two (P =0.821).4. Correlation analysis between FibroTouch and serum markers with pathological fibrosis stage of liver tissue, and the correlation coefficients were in the order of LSM (0.735)> FIB-4 (0.573)>HA (0.553) APRI (0.458)>A/G (five) (0.384).5. ROC curve area of S>2:LSM(0.888)>FIB-4(0.810)>APRI(0.789)>HA(0.796) ROC curve area of S>3:LSM (0.879)>FIB-4 (0.837)>APRI(0.816)>HA(0.816) ROC curve area of S=4:LSM (0.872)> HA(0.725)>FIB-4 (0.718)>APRI(0.539)6.The 6 independent predictors were selected by multiple linear regression:Spleen intercostals thickness, Body mass index(BMI), Serum albumin (ALB), Total bilirubin (TBiL), prothrombin time (PT),Type IV collagen (CIV).Conclusion:1. Both FibroTouch and ARFI can evaluate the degree of liver fibrosis in patients with chronic hepatitis B, and it has higher diagnostic value.2. FibroTouch in the diagnosis of chronic hepatitis B liver fibrosis is better than serological indicators.3. FibroTouch can better evaluate the degree of liver fibrosis, has a good application prospects and clinical value.4. In FibroTouch detection of liver stiffness, spleen thickness, BMI, TBiL, ALB, PT, CIV values may have an impact on the detection results, but the impact of the factors are still need to be further large sample multicenter study.