Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2017; 23(31): 5746-5754
Published online Aug 21, 2017. doi: 10.3748/wjg.v23.i31.5746
Diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase
You-Wen Tan, Xing-Bei Zhou, Yun Ye, Cong He, Guo-Hong Ge
You-Wen Tan, Xing-Bei Zhou, Yun Ye, Cong He, Guo-Hong Ge, Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
Author contributions: Tan YW and Zhou XB contributed equally to this work; Tan YW designed the research; Ye Y, He C and Ge GH collected and analysed the data, and drafted the manuscript; Zhou XB performed the research; Ye Y and He C interpreted the data and performed the statistical analysis; Tan YW revised the article; all authors have read and approved the final version to be published.
Institutional review board statement: The study was approved by the Medical Ethics Committee of the Third Hospital of Zhenjiang Affiliated Jiangsu University (No. 2013011).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at tyw915@sina.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: Dr. You-Wen Tan, Department of Hepatology, the Third Hospital of Zhenjiang Affiliated Jiangsu University, 300 Daijiamen, Zhenjiang 212001, Jiangsu Province, China. tyw915@sina.com
Telephone: +86-511-88614915 Fax: +86-511-88970796
Received: May 2, 2017
Peer-review started: May 4, 2017
First decision: June 6, 2017
Revised: June 10, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 21, 2017
Processing time: 109 Days and 0.5 Hours
Abstract
AIM

To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index (APRI), and liver stiffness measurement (LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase (PNALT).

METHODS

We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase (PIALT1) group [alanine transaminase (ALT) within 1-2 × upper limit of normal value (ULN)], and 64 in PIALT2 group (ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.

RESULTS

The pathological examination revealed moderate inflammatory necrosis ratios of 16.81% (16/95), 32.56% (28/86), and 45.31% (28/64), and moderate liver fibrosis of 24.2% (23/95), 33.72% (29/86), and 43.75% (28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group (P < 0.05). No significant difference was found in the areas under the curve (AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group (P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference (P > 0.05) was found in AUCs for all comparisons (P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI (P < 0.05).

CONCLUSION

APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

Keywords: Liver stiffness measurement; Hepatitis B virus; FIB-4; Aspartate aminotransferase-to-platelet ratio index; Normal; Alanine aminotransferase

Core tip: To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index (APRI), and liver stiffness measurement (LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase (PNALT), we enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase (PIALT1) group [alanine transaminase (ALT) within 1-2 × upper limit of normal value (ULN)], and 64 in PIALT2 group (ALT > 2 × ULN). The results showed that APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.