The diagnosis of liver fibrosis in chronic hepatitis B patients based on a transient elastography and serological model

Abstract

Abstract: Objective To explore the feasibility of using liver stiffness measurement (LSM) based on transient elastography and serological model to diagnose the severity of liver fibrosis in chronic hepatitis B (CHB) patients, and to provide a reliable method for noninvasive assessment of liver fibrosis. Methods The study enrolled 153 hepatitis B patients who underwent liver biopsies between January 2019 to January 2021. All patients had data on transient elastography and serological tests. Serum aspartate aminotransferase and platelet ratio index (APRI), AST/ALT ratio (AAR), liver fibrosis factor 4 index (FIB-4) of all patients were calculated. The Correlation between liver stiffness based on transient elastography, APRT, AAR, FIB-4 factor and the degree of liver fibrosis was analyzed using Spearman correlation method. The area under the curve (AUROC) was used to evaluate the efficacy of each index to diagnose liver fibrosis in CHB patients. Results 153 participants were included in the study. As confirmed by the pathological findings, The numbers of patients with fibrosis stages S1, S2, S3, and S4 were 32, 35, 10, and 76, respectively. Patients with stages≥S2 had significant fibrosis. The LSM, APRI, AAR, and FIB-4 factors were associated with the degree of liver fibrosis. The correlation coefficients were 0.737, 0.473, 0.516, and 0.720, respectively. As shown by the AUROC analysis, APRI had higher diagnostic efficacy in S2 than LSM, AAR, and FIB-4 factors. The diagnostic efficacy of LSM for S3 and S4 was higher than those of the other serological models; The specificity of the combination of LSM and FIB-4 factors for diagnosing fibrosis stages ≥ S2 was up to 96.8%. Conclusion Transient elastography is of certain clinical value in the diagnosis of liver fibrosis in CHB patients, and its combination with FIB-4 factor can exempt some of the patients from the necessity of liver puncture biopsy.

Key words: Chronic hepatitis B, Liver fibrosis, Transient elastography, Liver puncture biopsy

LIANG Kuo-peng, ZHANG Lei, LI Li-ping, ZHANG Dai-hui, WANG Xiao-juan, LI Jin-long, WANG Wen-chuan, MIAO Jie. The diagnosis of liver fibrosis in chronic hepatitis B patients based on a transient elastography and serological model[J]. Chinese Hepatolgy, 2025, 30(6): 784-788.

References

[1] Younossi Z M, Stepanova M, Rafiq N, et al. Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality[J]. Hepatology,2011,53(6):1874-1882.
[2] Lackner C, Tiniakos D. Fibrosis and alcohol-related liver disease[J]. J Hepatol,2019,70(2):294-304.
[3] Garcia T G, Friedman S, Iredale J, et al. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis[J]. Hepatology,2010,51(4):1445-1449.
[4] Lee S, Ahmed M, Taddei T, et al. The role of routine biopsy of the background liver in the management of hepatocellular carcinoma[J]. Hum Pathol,2023,138:18-23.
[5] Wong V W, Vergniol J, Wong G L, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease[J]. Hepatology,2010,51(2):454-462.
[6] Wai C T, Greenson J K, Fontana R J, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C[J]. Hepatology,2003,38(2):518-526.
[7] Sterling R K, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J]. Hepatology,2006,43(6):1317-1325.
[8] Wang J, Pu Y, Gong Y, Li Z, Zhu X. A statistical analysis of the correlations among various types of clinical indexes for patients with chronic hepatitis B: a hospital-based study. Medicine (Baltimore),2020,99(8):e19201.
[9] 张文胜, 王宝恩, 王泰龄, 等. 慢性乙型肝炎肝纤维化无创性诊断模型的建立[J]. 中华肝脏病杂志,2006(03):169-173.
[10] 王艳红. 非酒精性脂肪性肝病患者血清ALT、AST与肝纤维化的关系[J]. 中国现代药物应用,2023,17(09):15-18.
[11] Yin M, Ehman R L. MR elastography: practical questions, from the AJR special series on imaging of fibrosis[J]. AJR Am J Roentgenol,2023,222(1):e2329437..
[12] Yang K, Pan Y, Liu L, et al. Serum alpha-fetoprotein as a predictor of liver fibrosis in HBeAg-positive chronic hepatitis B patients[J]. Medicina (Kaunas),2023,59(5):923.
[13] 王雪鑫, 李颖霞, 姜利彬, 等. 实时剪切波弹性成像对自身免疫性肝炎纤维化的诊断价值[J]. 临床肝胆病杂志,2023,39(01):97-103.
[14] 陶贞贞, 王永莉, 孙红艳, 等. 二维剪切波弹性成像诊断慢性乙型肝炎患者肝纤维化价值研究[J]. 实用肝脏病杂志,2023,26(03):328-331.
[15] 陆伦根, 尤红, 谢渭芬, 等. 肝纤维化诊断及治疗共识(2019年)[J]. 临床肝胆病杂志,2019,35(10):2163-2172.
[16] Amernia B, Moosavy S H, Banookh F, et al. FIB-4, APRI, and AST/ALT ratio compared to fibroscan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran[J]. BMC Gastroenterol,2021,21(1):453.
[17] Lee J, Kim M Y, Kang S H, et al. The gamma-glutamyl transferase to platelet ratio and the FIB-4 score are noninvasive markers to determine the severity of liver fibrosis in chronic hepatitis B infection[J]. Br J Biomed Sci,2018,75(3):128-132.
[18] EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update[J]. J Hepatol,2021,75(3):659-689.