Value of Fibroscan combined with GPR,APRI,NFS or FIB-4 for progressive liver fibrosis in patients with chronic hepatitis B and nonalcoholic fatty liver disease

Objective To investigate the diagnostic value of FibroScan,gamma-glutamyl transpeptidase-to-platelet ratio( GPR),aspartate aminotransferase-to-platelet ratio index( APRI),nonalcoholic fatty liver disease( NAFLD) fibrosis score( NFS),and fibrosis-4( FIB-4) used alone or FibroScan combined with GPR,APRI,NFS,or FIB-4 for progressive liver fibrosis in patients with chronic hepatitis B( CHB) and NAFLD. Methods A total of 92 patients who underwent liver biopsy in Sichuan Provincial People's Hospital from November 2014 to August 2018 and were diagnosed with CHB and NAFLD were enrolled. Based on the SAF scoring system for liver biopsy,these patients were divided into mild-to-moderate liver fibrosis( F1 + F2) group with 69 patients and progressive liver fibrosis( F3) group with 23 patients. FibroScan was used to obtain liver stiffness measurement( LSM),and GPR,APRI,NFS,and FIB-4 were calculated based on clinical indices. The Mann-Whitney U test was used for comparison of continuous data between two groups. Spearman rank correlation was used for correlation analysis. A multivariate binary logistic regression analysis( forward stepwise regression) was used to construct combined predictive factors. The receiver operating characteristic( ROC) curve was plotted,and the area under the ROC curve( AUC) was calculated,and Delong method was used to compare the AUC to evaluate the early-warning value of each noninvasive diagnostic method used alone or in combination in the diagnosis of CHB and progressive liver fibrosis. Results The mild-to-moderate liver fibrosis group had significantly lower values of FibroScan,GPR,APRI,NFS,and FIB-4 than the progressive liver fibrosis group( Z =-4. 910,-3. 425,-3. 837,-3. 873,and-3. 990,all P < 0. 05). The correlation analysis showed that FibroScan,GPR,APRI,NFS,and FIB-4 were positively correlated with the pathological staging of liver fibrosis( r = 0. 518,0. 361,0. 405,0. 407,and 0. 418,P < 0. 05). FibroScan,GPR,APRI,NFS,and FIB-4 used alone had a certain clinical value in the diagnosis of progressive liver fibrosis( AUC = 0. 844,0. 740,0. 770,0. 771,and 0. 779,all P < 0. 001),while FibroScan was not superior to GPR,APRI,NFS,and FIB-4( P > 0. 05). FibroScan combined with GPR,APRI,NFS,or FIB-4 had a significantly higher AUC than GPR,APRI,NFS,or FIB-4 used alone in the diagnosis of progressive liver fibrosis( Z = 1. 977,2. 076,2. 361,and 2. 206,all P < 0. 05). FibroScan combined with these four indices had an AUC of 0. 896( 95% confidence interval: 0. 813-0. 950). Conclusion FibroScan,GPR,APRI,NFS,and FIB-4 have a certain clinical value in the diagnosis of progressive liver fibrosis,and FibroScan combined with GPR,APRI,NFS,or FIB-4 has higher efficiency than GPR,APRI,NFS,or FIB-4 used alone in the diagnosis of progressive liver fibrosis,among which FibroScan combined with NFS or FIB-4 may have the best clinical value.