关键词: 慢性乙型肝炎, 肝纤维化, 肝脏硬度检测, 谷氨酰转肽酶/血小板计数比值, 诊断

Abstract: Objective The aim of this study was to investigate the predicting performance of liver stiffness measurement (LSM) and serum glutamyl transpeptidase (GGT)/platelet (PLT) ratio combination in judging liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods A total of one hundred and seventy-five patients with CHB were encountered in our hospital between February 2019 and February 2021, and all patients had received nucleos(t)ides for antiviral therapy. The liver biopsies were performed and the LF was determined by METAVIR scoring system, the LSM was obtained by transient ultrasound elastography (FibroScan) and the GGT/PLT ratio was culculated. Serum laminin (LN), hyaluronidase (HA), type Ⅲ procollagen (PCⅢ) and Ⅳ-collagen levels were detected routinely. The multivariate Logistic analysis was applied to reveal the impacting factors for LF, and the area under the receiver operating characteristic curve (AUC) was applied to predict the efficacy of LSM and GGT/PLT ratio for the diagnosis of LF. Results Out the 175 patients with CHB, the liver histopathological examination showed significant LF in 25 cases(F₂ in 10 cases, F₃ in 9 cases and F₄ in 6 cases), and non- or minor-LF in 150 cases(F₀ in 138 cases, F₁ in 12 cases); the LSMs in patients with F₁, F₂, F₃ and F₄ were (5.3±1.1)kPa, (10.6±2.3)kPa, (14.1±3.4)kPa and (19.3±4.1)kPa, and the GPRs were (0.2±0.1), (0.3±0.1), (0.4±0.1) and (0.5±0.1), significantly different among them (P＜0.05); serum AST, ALT, PCⅢ, Ⅳ-C, HA levels and LSM and GPR in patients with significant LF were (69.3±6.4)U/L,(87.4±7.1)U/L,(17.6±3.2)ng/ml,(19.2±3.4)ng/ml,(96.2±9.9)ng/ml, (14.9±3.7)kPa and (0.4±0.1), all much higher than [(31.2±5.4)U/L, (31.1±4.5)U/L, (10.2±2.0)ng/ml, (13.4±2.4)ng/ml, (52.8±8.9)ng/ml,(5.9±1.1)kPa and (0.2±0.1), respectively, P＜0.05] in patients without significant LF; the multivariate Logistic analysis showed that serum Ⅳ-C and HA levels as well as the LSM and the GPR were all the independent risk factors for significant LF (P＜0.05); the ROC analysis demonstrated that the AUC was 0.975, with the sensitivity of 76.0% and the specificity of 98.0%, when the LSM, with the cut-off value of 10.4 kPa, and the GPR, with the cut-off value of 0.3, combination was applied to predict the significant LF. Conclusion As for the patients with CHB receiving nucleos(t)ides therapy, the LSM and GPR combination might predict significant LF, and warrants further clinical validation.

Key words: Hepatitis B, Liver fibrosis, Liver stiffness measurement, Glutamyl transpeptidase / platelet ratio, Diagnosis