The Value Of FIB-4,APRI Combined With Serum C?,PC? And LN In Diagnosis Of The Hepatitis B Cirrhosis

Objective:To evaluate the value of FIB-4,APRI,C?,PCIII and LN in the diagnosis of hepatitis B and liver cirrhosis by analyzing the relationship between FIB-4,APRI,C?,PCIII,LN and the degree of hepatic fibrosis.Methods: A retrospective analysis was performed for the clinical data of 243 patient with clinical confirmed CHB or liver cirrhosis and 30 patients with normal physical examination who visited our hospital and the Guilin third people's Hospital from October 2016 to June 2018.FIB-4,APRI was calculated and the C?,PCIII and LN was measured.An analysis of variance was used for comparison of normal distributed continue data,a rank-sum test was used for comparison of non-normal distributed data,The Spearman correlation analysis was performed.The area under the ROC curve of FIB-4,APRI,CIV,PCIII and LN for diagnosis of chronic hepatitis B and hepatitis B cirrhosis was analyzed with Med Calc15.6.1 statistical software.Sensitivity,specificity and area under the receiver operating characteristic curve(AUC)were used to evaluate these noninvasive techniques in the diagnosis of fibrosis.Results:1.Age,LN,APRI,FIB-4 were positively correlation with the clinical stage of liver fibrosis(r=0.528,0.422,0.545,0.768,all p<0.05),alanine aminotransferase,platelet(all p<0.05)were negatively correlation with the clinical stage of liver fibrosis(r=-0.276?-0.746,all p<0.05).2.The value of FIB-4,APRI,CIV,PCIII and LN in diagnosing chronic hepatitis B and hepatitis B cirrhosis were analyzed.The AUC of the PCIII and LN in diagnosing chronic hepatitis B was 0.59 and 0.58 respectively,so the PCIII and LN were eliminated.3.Selecting three indexes: APRI,FIB-4 and CIV,when diagnosing chronic hepatitis B with maximum sensitivity and specificity,the cut-off values were 0.32 for APRI,1.14 for FIB-4 and 40.60 ng/m L for CIV.When diagnosing chronic hepatitis B with specificity?95%,the cut-off value was 0.84 for APRI,2.44 for FIB-4 and 60.60 ng/m L for CIV.In the same way.The AUROC of APRI,FIB-4,CIV,LN for the diagnosis of hepatitis B liver cirrhosis were 0.813,0.910,0.655,0.744.Because PCIII diagnosed hepatitis B cirrhosis AUROC were 0.507,so it was eliminated.Selecting four indexes: APRI,FIB-4,CIV and LN,when diagnosing Hepatitis B cirrhosis with maximum sensitivity and specificity,the cut-off values were 1.01 for APRI,3.14 for FIB-4,86.45 ng/m L for CIV and 59.48 ng/ml for LN.When diagnosing Hepatitis B cirrhosis with specificity?95%,the cut-off value was 2.55 for APRI,3.72 for FIB-4,473.35 ng/m L for CIV and 270.09 ng/m L for LN.4.Binary logistic regression analysis identified FIB-4,IV-C and LN as independent predictors of fibrosis.A joint diagnostic model was established based on FIB-4,CIV and LN.The area under the ROC of the combined application of FIB-4,CIV and LN in the diagnosis of hepatitis B cirrhosis was 0.945,which was better than that under the ROC of FIB-4 combined CIV,FIB-4 combined LN,and LN combined CIV in the diagnosis of hepatitis B cirrhosis was 0.921,0.933,0.746 respectively.Conclusion:1.APRI,FIB-4,LN,CIV diagnose liver cirrhosis with hepatitis B,when selected the threshold with the maximum sum of the sensitivity and specificity can reduce missed diagnosis,when selected ?95% specificity as the diagnostic threshold can reduce misdiagnosis.2.The combined diagnosis model of FIB-4 combined with LN and CIV has important reference value for improving the diagnosis of hepatitis B cirrhosis.