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Volume 39 Issue 9
Sep.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(9): 2110-2116

Value of traditional noninvasive fibrosis models in diagnosis of significant liver fibrosis in patients with chronic hepatitis B and metabolic associated fatty liver disease

DOI: 10.3969/j.issn.1001-5256.2023.09.012
  • 1.

    The Second Clinical Medical College of Guangzhou University of Chinese Medicine，Guangzhou 510006，China

  • 2.

    Department of Hepatology，The Second Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510120，China

  • 3.

    Department of Hepatology，Guangdong Provincial Hospital of Traditional Chinese Medicine，Guangzhou 510120，China

Research funding:

The Thirteenth Five－Year Plan for Major and Special Programs of the National Science and Technology of China (2018ZX10725506－003);

The Thirteenth Five－Year Plan for Major and Special Programs of the National Science and Technology of China (2018ZX10725505－004);

The Science and Technology Research Project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine (YN10101903);

The Science and Technology Research Project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine (YN2016XP03);

Open Project of State Key Laboratory of Dampness Syndrome of Chinese Medicine (SZ2022KF02);

Chi Xiaoling of Project of Inheritance Workshop of Famous Old Chinese Medicine Experts of State Administration of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter ［2022］ No. 75);

The Fifth Batch of National Research and Training Programs for Clinical Talents of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter ［2022］ No. 1)

More Information
  • Corresponding author: XIAO Huanming， xiaohuanming@163.com （ORCID： 0000－0002－8739－0720）
  • Received Date: 2022-12-30
  • Accepted Date: 2023-02-27
  • Published Date: 2023-09-19
    Abstract
  •   Objective  To investigate the value of traditional noninvasive fibrosis models in the diagnosis of significant liver fibrosis in patients with chronic hepatitis B （CHB） and metabolic associated fatty liver disease （MAFLD）.  Methods  A total of 499 patients who underwent liver pathological examination in Department of Hepatology， Guangdong Provincial Hospital of Traditional Chinese Medicine， from September 2014 to December 2020 and met the diagnostic criteria for CHB and MAFLD were enrolled in this study. The Scheuer scoring system was used to evaluate the degree of liver fibrosis. The Mann－Whitney U test was used for comparison of normally distributed continuous data between groups. A Spearman correlation analysis was used to investigate the correlation of each noninvasive diagnostic method with the degree of liver fibrosis； the receiver operating characteristic （ROC） curve was plotted to investigate the value of FibroScan， gamma－glutamyl transpeptidase－to－platelet ratio （GPR）， aspartate aminotransferase－to－platelet ratio index （APRI）， fibrosis－4 （FIB－4）， and liver stiffness measurement－to－platelet ratio index （LPRI） in the diagnosis of CHB with MAFLD； a binary Logistic regression analysis was used to construct a combined model， and the area under the ROC curve （AUC） was compared between the combined model and the five indicators used alone. The DeLong method was used for comparison of AUC between any two noninvasive diagnostic methods.  Results  There were 198 patients in the group with no or mild liver fibrosis （S0－S1） and 301 patients in the group with significant liver fibrosis （S≥2）. The S≥2 group had higher clinical indicators than the S0－S1 group， with significant differences between the two groups in alanine aminotransferase， aspartate aminotransferase， gamma－glutamyl transpeptidase， total bilirubin， GPR， FIB－4， APRI， LPRI， and liver stiffness measurement （LSM） （all P<0.05）. The Spearman correlation analysis showed that GPR， FIB－4， APRI， LSM， and LPRI were positively correlated with the stage of liver fibrosis （r = 0.393， 0.414， 0.449， 0.553， and 0.580， all P<0.001）. The ROC curve analysis showed that GPR， FIB－4， APRI， LSM， and LPRI used alone had an AUC of 0.704， 0.715， 0.740， 0.787， and 0.802， respectively， in the diagnosis of significant liver fibrosis. The binary Logistic regression analysis was used to construct a combined LGAF model of GPR， FIB－4， APRI， and LSM， which had an AUC of 0.814 in the diagnosis of significant liver fibrosis. LGAF was compared with GPR， FIB－4， APRI， LSM， and LPRI， respectively， in terms of AUC， and the results showed that there was a significant difference between LGAF and all five indicators except LPRI （Z=5.184， 4.884， 4.117， and 2.120， all P<0.05）.  Conclusion  The five data models of FibroScan， GPR， APRI， FIB－4， and LPRI have a similar value in the diagnosis of significant liver fibrosis in CHB with MAFLD compared with the combined LGAF model， which provides reference and guidance for the application of noninvasive assessment of liver fibrosis in clinical practice.

     

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