Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4272
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
Pathological examination is known to be the gold standard for diagnosing liver fibrosis, as it enables a clear diagnosis of liver fibrosis grading. However, pathological examination is an invasive examination and cannot be used as a screening tool. At present, the degree of liver fibrosis is mainly evaluated by serological indicators in the clinic, however the accuracy is relatively low. With advances in technology, ultrasound elastography can be used to assess liver tissue stiffness, although the accuracy is not high. Therefore, it is necessary to explore reliable methods for diagnosing liver fibrosis and assessing the degree of liver fibrosis.
The motivation of this study is to find a more suitable method for the combined diagnosis of liver fibrosis and to establish an optimal non-invasive model for assessing the severity of liver fibrosis. This will provide a reference for non-invasive screening of liver fibrosis.
This study enrolled patients with chronic hepatitis B (CHB) as the research subjects. The aim of this study is to analyze serum markers and ultrasound elastography indicators for diagnosing liver fibrosis and liver fibrosis grading based on pathological results.
According to the results of liver biopsy, 338 patients with CHB admitted to our hospital were divided into a diseased group and control group. The diseased group continued to be divided into four groups according to the degree of fibrosis. General data, shear wave velocity (SWV), and serological markers were compared between the two groups. Further independent risk factors for liver fibrosis in patients were analyzed by logistic regression. The accuracy of different indicators in diagnosing liver fibrosis was compared by receiver operating characteristic (ROC) curves. The correlation between different fiber levels and serum indicators or elastography indicators was analyzed. Finally, a multivariate linear regression was used to establish a mathematical model for assessing the severity of liver fibrosis with elastography combined with serological markers.
SWV, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), hyaluronic acid (HA), type-IV collagen (CIV), aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factor (FIB-4) were significantly higher in the disease group than in the control group (P < 0.05). The multivariate logistic regression analysis results revealed that SWV, HA, CIV and 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%. Spearman correlation analysis revealed that hepatic fibrosis was positively correlated with SWV, AST/ALT, HA, CIV, APRI and FIB-4 levels. The R values were 0.767, 0.684, 0.711, 0.681, 0.634 and 0.702, respectively, and the difference was statistically significant (all P < 0.05). The multiple linear regression analysis revealed that SWV, AST/ALT, HA, CIV, APRI and FIB-4 were screened as statistically significant independent factors. The established model 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.
SWV can non-invasively and effectively diagnose liver fibrosis. SWV combined with serological indicators can further improve the accuracy of diagnosing liver fibrosis. The multiple linear regression equation established by SWV combined with serological indicators is expected to be a non-invasive tool for assessing the degree of liver fibrosis.
This study is a single-center study, and the sample size is limited and insufficient to fully guarantee the reliability of the study. Therefore, the equation we established cannot be used as an accurate tool for clinical prediction of lymph node metastasis, but it is worthy of further clinical validation and promotion. In addition, for serological indicators that can reflect the degree of liver fibrosis, we can further consult the literature to explore the mechanism of the degree of fibrosis. This would help us understand the diagnostic significance of serological markers with respect to the degree of liver fibrosis.