| Background&Aims:Currently,effective non-invasive assessment methods for liver fibrosis staging in patients with CHB are still lacked.The present study aimed to investigated alterations in thyroid hormone levels with fibrosis progression,and develop a novel diagnostic model for fibrosis staging in patients with chronic hepatitis B in a single-center cross-sectional study.MethodsA cross-sectional set of 417 chronic hepatitis B patients who underwent liver biopsy was enrolled,including deriving set 219 patients and validation set 198 patients.The METAVIR score was adopted as the reference of fibrosis staging.Trend test were analyzed with the Spearman rank correlation.Univariate and multivariate logistic regression analyses were performed to identify independent indicators of fibrosis stage in patients with CHB.To compare the predictive value of the different scoring systems,areas under the receiver operating curve(AUROCs)were calculated and compared by the Z test(Delong’s method).ResultsAmong thyroid hormones,only the level of free tetraiodothyronine(FT4)decreased gradually with the METAVIR fibrosis score(P<0.001).FibroStage,a novel diagnosis model that incorporates data on FT4,platelets,cholinesterase,gamma-glutamyl transpeptidase(GGT),and age,was developed using the deriving set(n=219).For the diagnosis of significant fibrosis,the FibroStage model had a significantly higher area under the receiver operating curve than did the FibroIndex,Forn,and Lok models(all of P<0.01)and tended to better than the FIB-4(fibrosis index based on four factors)(P=0.0791)but comparable with APRI(the aspartate transaminase-to-platelet ratio index)model(P=0.1694).For the diagnosis of advanced fibrosis,FibroStage had a higher area under the receiver operating curve than did APRI,FibroIndex,Forn,and Lok models(all of P<0.05)and had a comparable area under the receiver operating curve with the FIB-4 model(P=0.2109).For the diagnosis of cirrhosis,the area under the receiver operating curve of FibroStage was higher than those of APRI,FIB-4,FibroIndex,and Lok(all of P<0.05)models and was comparable with Forn(P=0.1649).These results was validated by a validation set(n=198).The optimized cutoff values of FibroStage for excluding and predicting significant and advanced fibrosis and cirrhosis were<-3.2and>-1.3,<-2.5and>-0.4,<-1.8and>0.9,respectively.The FibroStage outperformed,or was at least comparable with,any one of APRI,FIB-4,FibroIndex,Forn,and Lok regardless of the diagnosis of significant fibrosis,advanced fibrosis,or cirrhosis,and regardless of the patients’ treatment status before liver biopsy.ConclusionsThe level of free tetraiodothyronine(FT4)decreased gradually with the METAVIR fibrosis score.FT4 may be an indicator for fibrosis staging in chronic hepatitis B patients.A novel diagnostic model for the diagnosis of F2,F3,and F4 was developed and validated,and its comprehensive diagnostic accuracy was shown to be better than that of the APRI,FIB-4,FibroIndex,Forn,and Lok models.This novel diagnostic model would not only be applicable to CHB patients who have not received antiviral therapy,but also to CHB patients who had received antiviral therapy. |
