Objective To evaluate the clinical value of diagnosing liver fibrosis in HBeAg- negative chronic HBV infection patients with the level of alanine aminotransferase (ALT) <2 times upper limit of normal (ULN) by FibroScan.
Methods The clinical data of 363 HBeAg-negative chronic HBV infection patients performed liver biopsy with ALT<2ULN (ULN=40 U/L) were analyzed retrospectively, and liver stiffness measurement(LSM) was surveyed by FibroScan. Categorical variables were analyzed using the χ 2 test. T-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U or Kruskal-Wallis H(K) test was used for non-normally distributed continuous data. Useful parameters to use in the diagnosis of significant liver fibrosis were screened through single-factor and multiple-factor analysis. The diagnostic value of significant liver fibrosis was evaluated by ROC analysis.
Results Of the 363 patients, 259 (71.3%) had no significant liver fibrosis (F0- 1 group), and 104 (28.7% ) had significant liver fibrosis (F2- 4 group). LSM was independent risk factor for diagnosing of significant liver fibrosis through multiple-factor logistic regression analysis. The area under the ROC(AUROC) curve of LSM for diagnosing of significant liver fibrosis was 0.698(95% CI: 0.635-0.761). Taking LSM⩾5.75 kPa as the bound values, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 55.8%, 79.2%, 67.5%, 72.8% and 64.2%, respectively.
Conclusions LSM could diagnose the stage of liver fibrosis for HBeAg-negative chronic HBV infection patients with ALT<2ULN.
摘要： 目的 评估肝脏瞬时弹性扫描(FibroScan)诊断ALT<2ULN的HBeAg阴性慢性HBV感染者肝纤维化的临床 价值。 方法 纳入已行肝活检的363例ALT<2ULN(ULN=40 U/L)的HBeAg阴性慢性HBV感染者, 并用FibroScan测定 肝脏硬度值(1iver stiffness measurement, LSM)。计数资料组间比较采用 χ 2检验。满足正态分布的计量资料的组间比较 采用 t 检验, 不满足正态分布的采用Mann-Whitney U或Kruskal-Wallis H(K)检验; 单因素和多因素回归分析筛查ALT< 2ULN的HBeAg阴性慢性HBV感染者明显肝脏纤维化的指标; 受试者工作特征 (ROC) 曲线评估筛选指标对明显肝脏纤 维化的诊断价值。 结果 363例患者中259例(71.3%)非明显肝纤维化(F0~1组); 104例(28.7%)伴有明显肝纤维化(F2~4 组)。多因素分析显示LSM是肝脏明显肝纤维化的独立危险因素。LSM诊断明显肝纤维化的ROC曲线下面积 (AU- ROC) 是0.698(0.635~0.761)。以LSM≥5.75 kPa为界值, 预测明显纤维化的灵敏度为55.8%, 特异度为79.2%, 准确度为 67.5%, 阳性预测值为72.8%, 阴性预测值为64.2%。 结论 LSM对ALT<2ULN的HBeAg阴性慢性HBV感染者的肝纤维 化程度有诊断价值。