Abstract: Objective The aim of this study was to investigate the diagnostic performance of FibroScan and gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase to platelet ratio index (APRI)and fibrosis-4(FIB-4)for liver fibrosis (LF) evaluation in patients with chronic hepatitis B virus infection without serum alanine aminotransferase (ALT) level elevation. Method A total of 154 individuals with high serum HBV DNA loads and normal serum ALT levels were recruited in our hospital between February 2015 and December 2020, and all persons underwent liver biopsy, blood and serum parameters detection. Based on the Scheuer scoring system, the LF was determined, the liver stiffness measurement (LSM) was detected by FibroScan, and the GPR, APRI and FIB-4 were calculated. A multivariate binary Logistic regression analysis (Enter)was applied to construct predictive formulas, the receiver operating characteristic (ROC)curve was plotted, and the area under the ROC curve (AUC)was calculated, and compared by Delong method. Results Among the 154 individuals with chronic CHB infection, the liver histopathological examination showed significant LF (≥S2)in 73 cases(47.4%) and progressive LF (≥S3)in 25 cases(16.2%); the FIB-4, APRI, GPR and LSM in patients with ≥S2 were 1.0(0.8, 1.2), 0.3(0.2, 0.4), 0.2(0.2, 0.3) and 7.0(6.0, 9.0)kPa, and in patients with ≥S3 were 1.3(1.0, 1.7), 0.4(0.3, 0.5), 0.3(0.2, 0.4) and 9.0(7.4, 11.0)kPa, all significantly greater than [0.7(0.6, 1.0), 0.2(0.2, 0.3), 0.1(0.1, 0.2) and 5.0(4.1, 6.1)kPa, respectively, P<0.05] in persons with S0-S1; the predictive formula of the four parameter combination by Logistics regression analysis were as follows, Logit(≥S2)=1.303×FIB-4+9.8×GPR-0.684×APRI+0.7×LSM-7.565, with the AUC of 0.858 for predicting ≥S2 LF, and Logit(≥S3)=3.307×FIB-4+5.361×GPR-4.394×APRI+0.635×LSM-9.632, with the AUC of 0.914 for predicting ≥S3 LF, both superior to any parameter alone (all P＜0.001). Conclusion Nearly half of the individuals with chronic hepatitis B viral infection with normal serum ALT levels and detectable serum HBV DNA loads have significant LF or even progressive LF, and the FibroScan, GPR, APRI and FIB-4 might help non-invasively predict the existence of LF and warrants further investigation.

Key words: Hepatitis B virus carriers, Liver fibrosis, Gamma-glutamyl transpeptidase to platelet ratio, Aspartate aminotransferase to platelet ratio index, Fibrosis-4, alanine aminotransferase, Liver stiffness measurement, Diagnosis