Non-invasive Serum Fibrosis Markers Assessment Of Liver Fibrosis In Patients With Chronic Hepatitis B: FIB-4 Index And GP Model

Objective: To evaluate the diagnostic value and therapeutic effect of liver fibrosis by five simple non-invasive serum fibrosis markers: Fibrosis index based on the four factors(FIB-4),globulin-platelet model(GP),aspartate aminotransferase(AST)to alanine aminotransferase(ALT)ratio(AAR),AST to platelet ratio index(APRI)and glutamyltranspeptidase(GGT)platelet albumin index(S index)in patients with chronic hepatitis B.Methods: Part 1: A total of 140 patients with CHB who had undergone liver biopsy,laboratory testing at Ruikang Hospital,Nanning,China between September 2014 and January 2016 were recruited.Subjects were subdivided into 3 groups: no significant liver fibrosis group(Ishak score F0-F2),significant and severe fibrosis group(F3-F4)and cirrhosis group(F5-F6).Five models value was analyzed the differences and correlation between three groups.Diagnostic accuracies of these markers for prediction of significant fibrosis and cirrhosis were assessed by Receiver Operating Characteristic(ROC)curve analysis.Part 2: 57 patients of HBV-related cirrhosis(>F4)were recruited who were agreed with been treated by entecavir(ETV)combining with Fuzheng Huayu capsule and undergone liver biopsy after 48 weeks.We compared the score of FIB-4,GP,APRI and S index model before and after treatment.Results: Part 1: Excepting AAR,the all models had positive correlation with liver fibrosis stages(r=0.649,0.609,0.497,0.438,respectively,P<0.01).The AUROC of FIB-4,GP,AAR,APRI and S index for predicting significant fibrosis and cirrhosis were 0.825,0.804,0.433,0.741,0.729 and 0.867,0.845,0.568,0.788,0.740,respectively.For significant fibrosis,the sensitivity and specificity of FIB-4,GP,APRI and S index were 83.6%,82.2%,58.6%,81.5% and 77.1%,62.5%,77.1%,47.9%,respectively.For cirrhosis,the sensitivity and specificity of FIB-4,GP,AAR,APRI,and S index were 50.7%,44.1%,41.1%,46.1%,29.6% and 96.2%,91.1%,68.4%,89.9%,88.6%,respectively.The highest AUROC and positive predictive value(PPV)were 0.890 and 95% respectively(P< 0.01),when FIB-4 combined with GP for predicting cirrhosis.Part 2:33 patients were took second liver biopsy after 48 weeks.In addition to Ishak values and GP values no difference(P >0.05),APRI、FIB-4、S index value were higher before treatment than after(P< 0.05).Conclusion:Part 1: All models had positive correlation with the degree of liver fibrosis and can predict HBV-related fibrosis with an effective degree of accuracy,excepted AAR.The correlations and diagnostic values of FIB-4 and GP were better than others.A combination of FIB-4 with GP model can improve the performance to a better level for liver cirrhosis than that achieved by alone.Part 2:Entecavir combining with Fuzheng Huayu capsule were an effective treatment option for patients with HBV-related compensated cirrhosis of HBV DNA-positive.The GP model as a noninvasive model was maybe useful to predict the change of liver fibrosis in treatment process to CHB cirrhosis patients.