Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2017; 23(41): 7425-7432
Published online Nov 7, 2017. doi: 10.3748/wjg.v23.i41.7425
Value of gamma-glutamyltranspeptidase-to-platelet ratio in diagnosis of hepatic fibrosis in patients with chronic hepatitis B
Yan-Chao Hu, Hao Liu, Xiao-Yan Liu, Li-Na Ma, Yu-Hua Guan, Xia Luo, Xiang-Chun Ding
Yan-Chao Hu, Xiao-Yan Liu, Li-Na Ma, Yu-Hua Guan, Xia Luo, Xiang-Chun Ding, Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan 750001, Ningxia Hui Autonomous Region, China
Hao Liu, Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan 750001, Ningxia Hui Autonomous Region, China
Author contributions: Hu YC, Liu H, Liu XY, Ma LN, Guan YH, and Ding XC performed the study; Hu YC, Liu H, and Luo X collected and analyzed the data; and Hu YC designed the study and wrote the manuscript.
Supported by National Natural Science Foundation of China, No. 81460301 and No. 81760363; Key Project of Natural Science Foundation of Ningxia, No. NZ15134.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
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. Xiang-Chun Ding, Department of Infectious Disease, General Hospital of Ningxia Medical University, 804 Shengli Street, Yinchuan 750004, Ningxia Hui Autonomous Region, China. dingxiangchun@nyfy.com.cn
Telephone: +86-136-19511768
Received: August 5, 2017
Peer-review started: August 7, 2017
First decision: September 4, 2017
Revised: September 14, 2017
Accepted: September 29, 2017
Article in press: September 28, 2017
Published online: November 7, 2017
Processing time: 89 Days and 23.1 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatic fibrosis is a precursor of cirrhosis in patients with chronic hepatitis B (CHB). Severe hepatic fibrosis and cirrhosis can increase the incidence and mortality of primary liver cancer. Looking for a non-invasive, simple, easy to operate, cheap way to assess liver fibrosis is very important.

Liver biopsy is still the gold standard for the diagnosis of liver fibrosis, but it is not widely used as a routine examination because of its invasiveness, high cost, and lack of repeatability. As an alternative, transient elastography (Fibroscan) by imaging is considered a good tool for the diagnosis of hepatic fibrosis, but its performance is restricted by several factors.

Researchers have tried to identify a simple, convenient, cheap, and noninvasive index to assess patients’ hepatic fibrosis level, which could assist in early diagnosis to achieve timely treatment, delay cirrhosis or liver cancer occurrence, improve patients’ quality of life, and prolong patients’ survival time.

Research motivation

At present, liver biopsy is still the gold standard for the diagnosis of liver fibrosis, but liver biopsy can cause serious complications; thus, it is not preferred by most CHB patients in the clinic. Our study aimed to identify a simple, convenient, cheap, and noninvasive index to assess patients’ hepatic fibrosis level.

Research objectives

Our study aimed to identify a simple, convenient, cheap, and noninvasive index to assess patients’ hepatic fibrosis level. In the future, in our clinical work, assessing the level of liver fibrosis in patients is faster and easier, effectively avoiding the complications caused by liver biopsy.

Research methods

There were 652 outpatients and inpatients diagnosed with CHB at the General Hospital of Ningxia Medical University. Patients with severe heart, brain or kidney disease; severe infection; superinfection with hepatitis A virus, hepatitis C virus, hepatitis D virus, or hepatitis E virus or autoimmune liver disease; heavy drinking; or pregnancy were excluded. The remaining 390 newly diagnosed CHB patients, who did not undergo hepatoprotective, anti-hepatic fibrosis drug, or antiviral drug treatments, were selected for the study. We chose multiple noninvasive indicators for comparison, to illustrate that GPR is an optimal noninvasive index. Meanwhile, the sample size was large to enhance persuasiveness. Statistically analysed using SPSS17.0 software, the data are expressed as the mean ± SD. Normal distributed data were compared by t-test, and non-normally distributed data were compared using the Chi-square test. In addition, correlations were determined by Pearson correlation analysis; P < 0.05 indicated that the difference was statistically significant.

Research results

The GPR is a simple, convenient, cheap, and noninvasive index to assess patients’ hepatic fibrosis level, and it can significantly improve the sensitivity and specificity of hepatic fibrosis diagnosis in CHB when combined with the FIB-4 or APRI.

Research conclusions

The GPR is a newly reported model for evaluating the grade of hepatic fibrosis, which is of great value in predicting hepatic fibrosis. In June 2015, Lemoine et al first reported that the GPR could be widely used as an independent predictor to assess hepatic fibrosis in CHB patients in West Africa, and that the sensitivity of the GPR is higher than those of the APRI and FIB-4. GPR is a simple, convenient, cheap, and noninvasive index to assess patients’ hepatic fibrosis level, and it can significantly improve the sensitivity and specificity of hepatic fibrosis diagnosis in CHB when combined with the FIB-4 or APRI. In the future, in our clinical work, assessing the level of liver fibrosis in patients is faster and easier, effectively avoiding the complications caused by liver biopsy.

Research perspectives

In the future work, it is required to look for more noninvasive, convenient and efficient methods to assess the level of liver fibrosis in patients with chronic hepatitis B.