Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2018; 24(37): 4272-4280
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4272
Evaluation of elastography combined with serological indexes for hepatic fibrosis in patients with chronic hepatitis B
Bin Xu, Ning-Ming Zhou, Wei-Tian Cao, Xiao-Jing Li
Bin Xu, Ning-Ming Zhou, Wei-Tian Cao, Department of ultrasound, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
Xiao-Jing Li, Department of pathology, Fudan University affiliated Shanghai fifth people’s hospital, Shanghai 200240, China
Author contributions: Xu B designed research; Xu B, Cao WT, Li XJ performed research; Zhou NM contributed new reagents or analytic tools; Li XJ analyzed data; Xu B wrote the paper.
Supported by the Natural Science Research Project of Minhang District, No. 2013MHZ003.
Institutional review board statement: The study was approved by the ethics committee of Fudan University affiliated Shanghai fifth people’s hospital.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Data are available from the corresponding author at zhouningming@5thhospital.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ning-Ming Zhou, MD, Chief Doctor, Department of ultrasound, Fudan University affiliated Shanghai fifth people’s hospital, 128 Ruili road, Minhang district, Shanghai 200240, China. zhouningming@5thhospital.com
Telephone: +86-21-24289356 Fax: +86-21-24289356
Received: June 22, 2018
Peer-review started: June 22, 2018
First decision: July 25, 2018
Revised: August 6, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: October 7, 2018
Abstract
AIM

To investigate the value of ultrasound elastography combined with serological indexes in diagnosing liver fibrosis and assessing its severity.

METHODS

A total of 338 chronic hepatitis B (CHB) patients were divided into a disease group (patients with hepatic fibrosis) and control group (subjects without hepatic fibrosis). The disease group was further divided into S1-S4 according to the degree of fibrosis. Independent risk factors for hepatic fibrosis were analyzed using multivariate logistic regression. The diagnostic values of hepatic fibrosis from different indicators were compared using receiver operating characteristic (ROC) curves. The combination of elastography and serological indexes was explored to assess the severity of hepatic fibrosis.

RESULTS

The multivariate logistic regression analysis results revealed that shear wave velocity (SWV), hyaluronic acid (HA), type IV collagen (CIV) and aspartate aminotransferase-to-platelet ratio index (APRI) significantly affected the occurrence of hepatic fibrosis. The ROC curve revealed that the accuracy of the diagnosis of hepatic fibrosis for SWV and HA were 87.3% and 84.8%, respectively. The accuracy of SWV combined with HA was 88.9%. The multiple linear regression analysis revealed that SWV, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), HA, CIV, APRI and fibrosis index based on the 4 factor (FIB-4) were screened as statistically significant independent factors. The established regression equation was: Fibrosis level = -4.046 + 1.024 × SWV + 1.170 × AST/ALT + 0.011 × HA + 0.020 × CIV + 0.719 × APRI + 0.379 × FIB-4.

CONCLUSION

SWV combined with serological indexes can improve the accuracy of diagnosis for CHB hepatic fibrosis. Serum indexes can help diagnose the degree of hepatic fibrosis.

Keywords: Elastography, Serology, Hepatic fibrosis, Non-invasive diagnosis

Core tip: Hepatic fibrosis affects the physiological function of the liver. The current assessment method for the degree of hepatic fibrosis is still unreliable. This study found that the shear wave velocity of ultrasound elastography can improve the accuracy of the diagnosis of hepatic fibrosis. Its combination with serological indicators (aspartate aminotransferase/alanine aminotransferase, hyaluronic acid, type IV collagen, aspartate aminotransferase-to-platelet ratio index and fibrosis index based on the 4 factor) can further help in the clinical assessment of the degree of hepatic fibrosis.