Clinical Value Of Chitinase-3-like Protein 1 Level In Noninvasive Detecting Liver Fibrosis In Patients With Chronic Hepatitis B Virus Infection

BackgroundSerum chitinase 3-like protein 1(CHI3L1)is secreted by macrophages,etc.,involved in pathological processes such as inflammation,cell proliferation and differentiation,and extracellular matrix reconstruction.It is a promising biomarkers for liver fibrosis assessment.This article aims to evaluate serum CHI3L1 as a noninvasive diagnostic marker for chronic hepatitis B virus(HBV)related liver fibrosis.MethodsSerum CHI3L1 level was measured by ELISA in 180 patients with chronic HBV infection,including 46 chronic HBV carriers(HBV-C),134 chronic hepatitis B(CHB)patients.Its performance was assessed and compared to other noninvasive tests by the receiver-operating characteristic(ROC)analysis.ResultsSerum CHI3L1 level was strongly associated with HBV-related liver fibrosis,positively correlated with liver fibrosis evaluation indicators(AST,ALP,GGT),and negatively correlated with ALB.Serum CHI3L1 level was positively correlated with liver stiffness measurement(LSM),and increased with the fibrosis stages(F0-1 to F4)(P<0.001).For this study,significant fibrosis was defined as a liver stiffness measurement(LSM)of >9.7 k Pa.The CHB patients were divided into two groups with significant liver fibrosis(? F2)and no significant liver fibrosis(<F2).The serum CHI3L1 median concentration in patients with significant liver fibrosis was 81.91(59.14,120.45)ng/m L,while the median concentration in patients without significant liver fibrosis was 56.48(45.72,76.10)ng/m L,there were statistical difference(P<0.001).In CHB patients,the specificity and sensitivity of CHI3L1 for predicting significant fibrosis were 75.60% and 59.10%,respectively,having a cut-off of 75.97ng/m L with the area under the ROC curve(AUC)of 0.728(95% CI: 0.637-0.820).Furthermore,the performance of CHI3L1 was superior to that of aspartate aminotransferase to platelet ratio index(APRI)(0.583,95% CI: 0.472-0.694)(P=0.036)and quite to fibrosis index based on four factors(FIB-4)(0.631,95% CI: 0.521-0.741)(P=0.178)in identifying significant fibrosis in subjects with HBV in China.A follow-up analysis of 8 patients who had undergone liver biopsy,with disproportionate serum CHI3L1 and LSM.It revealed that CHI3L1 had a better agreement with liver biopsy than the LSM.Among fifty CHB patients undergoing liver biopsy,serum CHI3L1 levels increased with the degree of liver fibrosis(S0 to S3-4)(P<0.001).Among the 34 CHB patients,there were differences in serum CHI3L1 levels before and after antiviral treatment.The median serum concentration before treatment was 73.38(52.25,111.28)ng/m L,and the median concentration after antiviral treatment for 6 months was 49.29(33.61,67.10)ng/m L(P<0.001).ConclusionSerum CHI3L1 level is correlated with various liver fibrosis evaluation indexes.Serum CHI3L1 is superior to traditional serum indicators such as HA and PIIINP.For different stages of liver fibrosis,serum CHI3L1 has a good correlation with transient elastography,and at the same time,it has a better consistency with liver pathology.Serum CHI3L1 can be used as a serum marker for long-term follow-up of CHB antiviral therapy efficacy and liver fibrosis changes.Studies have found that the level of serum CHI3L1 after antiviral treatment has decreased.Serum CHI3L1 can be used for non-invasive diagnosis of liver fibrosis in patients with chronic HBV infection.To a certain extent,it can replace liver biopsy as an indicator of liver fibrosis diagnosis.