| ObjectiveTo investigate the histopathological characteristics and clinical significance of liver in patients with chronic hepatitis B virus(HBV)infection,and explore the diagnostic performance of noninvasive diagnostic models APRI、FIB-4、RPR、S index、GPR and GAPI in judging hepatic inflammation and fibrosis stages,taking liver biopsy results as the gold standard.MethodsThe clinicopathological data of 209 patients with chronic HBV infection who underwent liver biopsy at The First People’s Hospital of Soochow University and the Fifth People’s Hospital of Wuxi from June 2018 to June 2021 were collected,including general information such as age,sex,height and weight of all patients,the results of liver histopathological examination and serological indexes of all patients,and all serological indexes were tested within one week before the liver biopsy.Their liver pathological changes and correlation with clinical features were analyzed.APRI,FIB-4,RPR,S index,GPR,GAPI were calculated according to the formula and the subject operating characteristic curve(ROC curve)was plotted,The diagnostic performance of each diagnostic model was evaluated and compared using the area under curve(AUC),diagnostic test evaluation indexes(sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy).The pathological staging criteria of liver were adopted from the pathological diagnostic criteria of chronic hepatitis revised in 1995 in China,G0-G1 was defined as no significant inflammation,≥G2 as significant inflammation,G3 as moderate inflammation,and G4 as severe inflammation.S0-S1 was defined as no significant fibrosis,≥S2 as significant fibrosis,≥S3 as advanced fibrosis,and S4 as early cirrhosis.Results1.A total of 209 patients were included in this study,of whom 129(61.72%)were male,80(38.28%)were female,57(27.27%)had a family history of hepatitis B,69(33.01%)were HBeAg positive,and the mean age was(41.74±l0.00)years old.Pathological examination of liver puncture showed that 44(21.95%)patients had combined hepatic steatosis,198(94.74%)patients had positive staining for hepatitis B surface antigen(HBsAg)in liver tissue,and 128(61.24%)patients had positive staining for hepatitis B core antigen(HBcAg)in liver tissue.The grading and number of liver tissue inflammation were 2(0.96%)for G0,74(35.41%)for G1,96(45.93%)for G2,37(17.70%)for G3,respectively;the fibrosis stage and number of cases were 5(2.39%)for S0,48(22.97%)for S1,78(37.32%)for S2,38(18.18%)for S3,and 40(19.14%)for S4,respectively.2.In the comparison between the two groups with and without significant liver inflammation,albumin(ALB),platelets(PLT),red blood cell distribution width(RDW),alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transferase(GGT),alkaline phosphatase(ALP),hepatitis B e antigen positive(HBeAg)cases,hepatitis B virus Deoxyribonucleic acid(HBV-DNA)copy number were significantly different;multifactorial analysis showed that RDW,ALT,PLT,and HBV-DNA copy number were independent predictors of the presence of significant inflammation in patients.In the comparison between the two groups with and without significant liver vascularization,there were significant differences between ALB,PLT,ALT,AST,GGT,ALP and age.Multifactorial analysis showed that PLT,age and ALT were independent predictors of the development of significant liver fibrosis in patients(all P<0.05).3.The AUCs of APRI,FIB-4,RPR,S index,GPR,and GAPI for diagnosing≥G2 were 0.746,0.642,0.684,0.722,0.713,and 0.707,respectively,with APRI outperforming FIB-4(Z=3.117,P=0.002)and no significant differences between the remaining models(all P>0.05),with comparable diagnostic performance.The sensitivity of GAPI was the highest at 67.67%;the specificity of GPR was the highest at 84.21%;the positive predictive value of GPR was the highest at 85.00%;the negative predictive value of APRI was the highest at 54.16%;and the accuracy of APRI was the highest at 67.99%.APRI,FIB-4,RPR,S index,GPR,and The AUCs of GAPI for diagnosing G3 were 0.859,0.789,0.792,0.866,0.847,and 0.845,respectively,and the performance of S index was better than that of FIB-4(P=0.048);the comparisons among the remaining models were not significantly different(all P>0.05),and the diagnostic performances were comparable.The sensitivity was highest with GAPI at 91.89%,the specificity was highest with APRI at 86.05%,the positive predictive value was highest with APRI at 54.84%,the negative predictive value was highest with GAPI at 97.36%,and the accuracy was highest with APRI at 84.69%.4.The AUCs of APRI,FIB-4,RPR,S index,GPR,and GAPI for the diagnosis of≥S2 were 0.757,0.681,0.701,0.701,0.685,and 0.719,respectively,with APRI outperforming GPR and FIB-4(P=0.045;P=0.023).The comparison between the remaining models was not significantly differences(P>0.05),and the diagnostic performance was comparable.The sensitivity was highest with APRI at 78.20%,the specificity was highest with S index at 92.45%,the positive predictive value was highest with S index at 93.21%,the negative predictive value was highest with APRI at 50.01%,and the accuracy was highest with APRI at 74.65%.The AUCs of APRI,FIB-4,RPR,S index,GPR,and GAPI for diagnosing≥ S3 were 0.760,0.716,0.804,0.800,0.797,and 0.806,respectively,with the performance of GAPI,GPR,RPR,and S index was better than that of FIB-4(all P<0.05),and the comparisons among the remaining models were not significantly differences(all P>0.05),with comparable diagnostic performance.The sensitivity was highest with RPR at 85.90%;specificity was highest with S index at 87.79%;positive predictive value was highest with S index at 75.76%;negative predictive value was highest with RPR at 88.30%;and accuracy was highest with S index at 78.95%.The AUCs of APRI,FIB-4,RPR,S index,GPR,and GAPI for diagnosing S4 were 0.835,0.795,0.868,0.870,0.872,and 0.852,respectively,with GPR,RPR,and S index performing better than FIB-4(all P<0.05).The comparison between the remaining models was not significantly different(all P>0.05),and the diagnostic performance was comparable.The sensitivity was highest with S index at 95.00%,the specificity was highest with RPR at 85.80%,the positive predictive value was highest with RPR at 54.72%,the negative predictive value was highest with S index at 98.21%%,and the accuracy was highest with RPR at 83.25%.5.In assessing the degree of inflammation(excluding G4),APRI,S index,GPR,and GAPI were the high combined diagnostic performance group,and FIB-4 and RPR were the moderate combined diagnostic performance group.In assessing fibrosis,APRI,RPR,S index,and GAPI were the high diagnostic performance group,GPR was the moderate diagnostic performance group,and FIB-4 was the low diagnostic performance group.Conclusion1.RDW,PLT,ALT and HBV-DNA copy number were independent predictors of significant inflammation in patients with chronic HBV infection;age,PLT and ALT were independent predictors of significant liver fibrosis in patients with chronic HBV infection.2.All six noninvasive diagnostic models had some reference value in assessing the degree of inflammation(excluding G4)and fibrosis staging.APRI,S index,GPR,and GAPI had moderate and good diagnostic performance in diagnosing significant inflammation and moderate inflammation.APRI,RPR,S index,and GAPI had moderate diagnostic performance in diagnosing significant fibrosis;RPR,S index,and GAPI had good diagnostic performance in diagnosing advanced liver fibrosis;APRI,RPR,S index,GPR,and GAPI had good diagnostic performance in the diagnosis of early cirrhosis.APRI,S index,and GAPI had high reference value in assessing liver inflammation and fibrosis. |
