| Hepatic fibrosis is a necessary stage in the progression of chronic liver diseases to cirrhosis.There are many causes of liver fibrosis,among which infection with HBV is the most common.Accurate evaluation of the different stages of chronic hepatitis B live fibrosis,differentiation liver fibrosis and early cirrhosis are crucial aspects to evaluate the condition and guide the treatment.At present,the diagnosis of liver fibrosis mainly relies on liver biopsy,but the invasive nature limits its clinical application.Transient elastography(Fibro Scan)is a reliable method for non-invasive evaluation of liver fibrosis,but it is expensive.Therefore,scholars at home and abroad have constructed a variety of non-invasive serum diagnostic models,such as aspartate aminotransferase to platelet ratio index(APRI),liver fibrosis 4 index(FIB-4),however these models cannot be independent predict early cirrhosis and the liver fibrosis progression,the sensitivity and specificity to further perfect.Related studies had shown that miR-30 a,miR-29 c involved in the occurrence and development of liver fibrosis,however,the predictive value of circulating miR-30 a and miR-29 c in different degrees of liver fibrosis and early cirrhosis of hepatitis B remains to be further studied.Objective: Through comparison the expression of plasma miR-30 a,miR-29 c and FIB-4,APRI scores in patients with chronic hepatitis B in different liver fibrosis stages and early cirrhosis,to explore the predictive values of plasma miR-30 a,miR-29 c and FIB-4,APRI scores in patients with chronic hepatitis B in different degrees of liver fibrosis and early cirrhosis,and to establish the predictive model of early cirrhosis.Methods: A total of 120 patients with chronic hepatitis B and 40 healthy volunteers were selected in Hebei Provincial General Hospital from January 2018 to December 2019 and were divided into F0-F2 group(mild-moderate liver fibrosis),F3 group(severe liver fibrosis),F4 group(early liver cirrhosis)and healthy control group according to the results of Fibro Scan,40 cases in each group.The expression of plasma mir-30 a,mir-29 c in each group was detected by q RT-PCR,clinical datas were collected and FIB-4,APRI scores were calculated.The predictive value of each indicator was evaluated by receiver operating characteristic curve(ROC)and the predictive model of early cirrhosis was established by Logistic regression analysis.Results:1.Relative expression levels of plasma miR-30 a,miR-29 c in different groups: Relative expression levels of plasma miR-30 a,miR-29 c in each group of patients with chronic hepatitis B were significantly lower compared with control group,with statistical difference(P<0.05),with the increase of liver fibrosis degree,the relative expression levels of miR-30 a,miR-29 c gradually reduced,miR-30 a have statistical difference in F0-F2 and F4 group(P<0.05);miR-29 c were statistically different in F0-F2 and F4 group,F3 and F4 group(P<0.05).2.The comparison of FIB-4,APRI scores in different groups: FIB-4 in each group of patients with chronic hepatitis B were significantly higher than control group(P<0.05).APRI in each group of patients with chronic hepatitis B were higher than control group,there was a statistical difference between F4 group and control group(P<0.05).With the increase of liver fibrosis degree,FIB-4 and APRI gradually increased,and there were statistical differences in F0-F2 and F4 group,F3 and F4 group(P < 0.05).3.The predictive value of plasma mir-30 a,mir-29 c,fib-4 and APRI: The AUC of miR-30 a,miR-29 c,FIB-4 and APRI were 0.782,0.839,0.775 and 0.750,respectively,in discriminating healthy people from patients with hepatitis B liver fibrosis and early cirrhosis.The AUC of miR-30 a,miR-29 c,FIB-4 and APRI were 0.736,0.741,0.735 and 0.726,respectively,in discriminating patients with hepatitis B mild-moderate liver fibrosis from severe liver fibrosis and early cirrhosis.The AUC of mir-30 a,mir-29 c,FIB-4 and APRI were 0.705,0.781 and 0.799,respectively,in discriminating patients with hepatitis B liver fibrosis from early cirrhosis.4.Establishment of predictive model for early cirrhosisThe results of Logistic regression analysis of miR-30 a,miR-29 c,FIB-4,APRI showed that: miR-29 c,FIB-4,APRI were independent factors affecting the progression of liver fibrosis to early cirrhosis,and a predictive model for early cirrhosis was established: Y=2.717 × FIB-4+2.043 ×APRI-0.86×miR-29 c,the cut-off value is-3.048 and the AUC is 0.95.The use of this model generated 90% sensitivity,90% specificity,and 0.95 AUC,with a cut-off value of-3.048,offering superior performance compared with single indicator.Conclusions:1.Plasma miR-30 a,miR-29 c,FIB-4 and APRI have predictive effects on each stage of chronic hepatitis B liver fibrosis and early cirrhosis.2.the predictive model of early cirrhosis can better predict early cirrhosis.The predictive model for early cirrhosis show: Y=2.717 × FIB-4+ 2.043×APRI-0.86×miR-29 c,with the cut-off value of-3.048,the prediction efficiency of the model is better than the single index. |
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