Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2016; 22(29): 6663-6672
Published online Aug 7, 2016. doi: 10.3748/wjg.v22.i29.6663
Noninvasive models for assessment of liver fibrosis in patients with chronic hepatitis B virus infection
Da-Wu Zeng, Jing Dong, Yu-Rui Liu, Jia-Ji Jiang, Yue-Yong Zhu
Da-Wu Zeng, Jing Dong, Yu-Rui Liu, Jia-Ji Jiang, Yue-Yong Zhu, Liver Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Dong J prepared the tables; Zhu YY designed the research; Zeng DW, Liu YR and Jiang JJ wrote the manuscript.
Conflict-of-interest statement: There are no conflicts of interest involved in the manuscript.
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: Yue-Yong Zhu, MD, PhD, Liver Center, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. ezhu066@sina.com
Telephone: +86-591-87981660 Fax: +86-591-83356180
Received: March 16, 2016
Peer-review started: March 18, 2016
First decision: May 12, 2016
Revised: May 30, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 7, 2016
Abstract

There are approximately 240 million patients with chronic hepatitis B virus (HBV) infection worldwide. Up to 40% of HBV-infected patients can progress to liver cirrhosis, hepatocellular carcinoma or chronic end-stage liver disease during their lifetime. This, in turn, is responsible for around 650000 deaths annually worldwide. Repeated hepatitis flares may increase the progression of liver fibrosis, making the accurate diagnosis of the stage of liver fibrosis critical in order to make antiviral therapeutic decisions for HBV-infected patients. Liver biopsy remains the “gold standard” for diagnosing liver fibrosis. However, this technique has recently been challenged by the development of several novel noninvasive tests to evaluate liver fibrosis, including serum markers, combined models and imaging techniques. In addition, the cost and accessibility of imaging techniques have been suggested as additional limitations for invasive assessment of liver fibrosis in developing countries. Therefore, a noninvasive assessment model has been suggested to evaluate liver fibrosis, specifically in HBV-infected patients, owing to its high applicability, inter-laboratory reproducibility, wide availability for repeated assays and reasonable cost. The current review aims to present the status of knowledge in this new and exciting field, and to highlight the key points in HBV-infected patients for clinicians.

Keywords: Liver biopsy, Hepatitis B, Noninvasive, Serum biomarkers, Fibrosis

Core tip: An accurate diagnosis of liver fibrosis is essential to make therapeutic decisions in patients with chronic hepatitis B (CHB). However, liver biopsy, the “gold standard” for assessing the degree of liver fibrosis, has been limited by its complications. Although noninvasive models composed with serum biomarkers were applied to assess fibrosis in patients with CHB, they have been suggested owing to their high applicability, inter-laboratory reproducibility, wide availability for repeated assays and cost. Previous data presented on the noninvasive models for assessing liver fibrosis from different levels of alanine aminotransferase have been limited.