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CN 22-1108/R
Volume 40 Issue 9
Sep.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(9): 1790-1795

Establishment of a noninvasive diagnostic model for chronic hepatitis B liver fibrosis patients with normal aminotransferases aged ≤30 years

DOI: 10.12449/JCH240912
  • 1.

    Department of Infectious Diseases，The First Hospital of Changsha，Changsha 410000，China

  • 2.

    Second Department of Liver Diseases，Shenzhen Third People’s Hospital，Shenzhen，Guangdong 518112，China

Research funding:

Key Discipline Construction Project of Shenzhen (SZXK076)

More Information
  • Corresponding author: WANG Fang， 807874297@qq.com （ORCID： 0009-0003-0092-3403）; LU Jin， 2276984@qq.com （ORCID： 0000-0003-0035-1890）
  • Received Date: 2024-01-29
  • Accepted Date: 2024-03-18
  • Published Date: 2024-09-25
    Abstract
  •   Objective  To establish a noninvasive diagnostic model for liver fibrosis in chronic hepatitis B （CHB） patients with normal alanine aminotransferase （ALT） and an age of ≤30 years by selecting specific indicators from the commonly used noninvasive indicators such as clinical， biochemical， and imaging indicators， to avoid invasive liver biopsy in such patients to some extent， and to guide the timing of antiviral therapy.  Methods  A total of 251 CHB patients with normal ALT and an age of ≤30 years who underwent liver biopsy in Shenzhen Third People’s Hospital and The First Hospital of Changsha from January 2019 to January 2022 were enrolled， with 175 patients in the model group and 76 patients in the validation group， and commonly used clinical indicators were obtained based on clinical experience and related articles. The two-independent-samples t test or the two-independent-samples Mann-Whitney U rank sum test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. A Spearman rank correlation analysis was used to investigate the correlation between each indicator and liver fibrosis and identify the indicators with correlation （P<0.01， r>0.200）； a Logistic regression analysis was used to establish a noninvasive diagnostic model， and the receiver operating characteristic （ROC） curve was used to evaluate its performance and perform validation of the model； this model was then compared with the widely used models of aspartate aminotransferase-to-platelet ratio index （APRI） and fibrosis-4 （FIB-4）. The Kappa consistency test was used to investigate the consistency of pathological results.  Results  A total of 17 commonly used clinical indicators were obtained， among which 9 indicators （ALT， aspartate aminotransferase ［AST］， gamma-glutamyl transpeptidase ［GGT］， ferritin ［FERR］， platelet count ［PLT］， procollagen type Ⅲ amino-terminal peptide ［PⅢP］， collagen Ⅳ ［CⅣ］， HBV DNA， and spleen thickness） were correlated with liver fibrosis （P<0.01， r>0.232）. Based on the above indicators， the predictive model was established as P=1/（1+e-γ）， γ=-1.902+0.106×AST－0.011×PLT－0.265×HBV DNA+0.059×PⅢP， in which P was the probability for predicting ≥S2 liver fibrosis and γ was the predictive index. The comparison between each indicator and the model showed that the model had the largest area under the ROC curve of 0.852， with a sensitivity of 92.7% and a specificity of 76.9%. The model was validated in 76 patients and showed an accuracy of 77.600%. The model was compared with APRI and FIB-4， and the results showed that the model has good accuracy.  Conclusion  Compared with the models of APRI and FIB-4 commonly used in the world， this model can more accurately judge the degree of liver fibrosis in such patients， thereby replacing liver biopsy to some extent and guiding the timing of antiviral therapy.

     

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