Value of five noninvasive diagnostic techniques and their combinations in diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective To investigate the correlation of aspartate aminotransferase to platelet ratio index( APRI),FIB-4,Forns index,S index,and Fibro Scan with the degree of liver fibrosis,the diagnostic value of these techniques used alone or in combination,and the clinical value of these noninvasive techniques in the assessment of the degree of liver fibrosis in patients with chronic hepatitis B( CHB). Methods A retrospective analysis was performed for the clinical data of 91 patients with pathologically confirmed CHB who visited General Hospital of Ningxia Medical University and underwent liver biopsy from January 2009 to April 2015. According to the Scheuer pathological stage and liver fibrosis stage( S),the patients were divided into non-liver fibrosis group( a liver fibrosis stage of S0,32 patients),mild liver fibrosis group( a liver fibrosis stage of < S2,30 patients),and marked liver fibrosis group( a liver fibrosis stage of ≥S2,29 patients). The APRI,FIB-4,Forns index,and S index were calculated,and liver stiffness was measured by Fibro Scan. An analysis of variance was used for the comparison of normally distributed continuous data between three groups,and the Dunnett t-test was used for further comparison between any two groups. The Spearman correlation analysis was also performed. Sensitivity,specificity,and area under the receiver operating characteristic curve( AUC) were used to evaluate the value of these noninvasive techniques in the diagnosis of liver fibrosis. Results There were significant differences in age,albumin,aspartate aminotransferase,alanine aminotransferase,and platelet count between the three groups( F = 3. 552,4. 035,4. 374,and 5. 992,all P < 0. 05),and there were significant differences in these parameters between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05). There were significant differences in APRI,FIB-4,Forns index,S index,and Fibro Scan between the three groups( F = 4. 579,5. 728,10. 501,14. 118,and 30. 039,all P < 0. 05); there were significant differences in these indices between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05),and there was a significant difference in Fibro Scan between the mild liver fibrosis group and the marked liver fibrosis group( P < 0. 05). APRI,FIB-4,Forns index,S index,and Fibro Scan were positively correlated with the pathological stage of liver fibrosis( r = 0. 499,0. 498,0. 402,0. 395,and 0. 739,all P < 0. 05). APRI,FIB-4,Forns index,S index,or Fibro Scan alone has certain value in the diagnosis of liver fibrosis,with an AUC( 95% CI) of 0. 786( 0. 679-0. 892),0. 818( 0. 717-0. 918),0. 770( 0. 661-0. 880),0. 718( 0. 599-0. 837),or 0. 919( 0. 864-0. 974)( all P < 0. 01). When APRI,FIB-4,Forns index,or S index was combined with Fibro Scan,the AUC( 95% CI) was increased to 0. 922( 0. 868-0. 976),0. 931( 0. 881-0. 981),0. 926( 0. 873-0. 979),and 0. 918( 0. 862-0. 974),respectively. A combination of APRI,FIB-4,Forns index,S index,and Fibro Scan increased the AUC( 95% CI) to 0. 927( 0. 875-0. 979). Conclusion APRI,FIB-4,Forns index,S index,and Fibro Scan are significantly positively correlated with liver fibrosis grade. A combination of these indices can increase the accuracy of the diagnosis of liver fibrosis and has a similar value as pathological diagnosis and a certain value in the early diagnosis of liver fibrosis. Moreover,it can guide the selection of the timing of antiviral therapy in clinical practice.