Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2020; 26(27): 3952-3962
Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3952
Serum ceruloplasmin can predict liver fibrosis in hepatitis B virus-infected patients
Na-Ling Kang, Jie-Min Zhang, Meng-Xin Lin, Xu-Dong Chen, Zu-Xiong Huang, Yue-Yong Zhu, Yu-Rui Liu, Da-Wu Zeng
Na-Ling Kang, Yue-Yong Zhu, Yu-Rui Liu, Da-Wu Zeng, Liver Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Jie-Min Zhang, Department of Pharmacy, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Meng-Xin Lin, Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated with Fujian Medical University, Quanzhou 362000, Fujian Province, China
Xu-Dong Chen, Department of Gastroenterology, the 910th Hospital of the People's Liberation Army, Quanzhou 362000, Fujian Province, China
Zu-Xiong Huang, Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Kang NL, Zhang JM, Lin MX, and Huang ZX contributed equally to this work; Kang NL, Zeng DW, and Liu YR conceived and designed the experiments; Kang NL, Zhang JM, and Zeng DW performed the experiments; Chen XD, Huang ZX, Lin MX, Zhang JM, and Zhu YY analyzed the data; Kang NL, Zhang JM, Chen XD, Huang ZX, and Lin MX contributed reagents/materials/analysis tools; Kang NL, Zhang JM, and Zeng DW wrote the manuscript.
Supported by the Science and Technology Department of Fujian Province, No. 2018J01164; Quanzhou Science and Technology Bureau Planning Project, No. 2019N019S.
Institutional review board statement: This study was approved by the Institutional Review Board of Fujian Medical University.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Da-Wu Zeng, MD, PhD, Associate Chief Physician, Doctor, Liver Center, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. zengdw1980@fjmu.edu.cn
Received: March 17, 2020
Peer-review started: March 17, 2020
First decision: April 25, 2020
Revised: May 6, 2020
Accepted: June 30, 2020
Article in press: June 30, 2020
Published online: July 21, 2020
ARTICLE HIGHLIGHTS
Research background

Chronic hepatitis B virus (HBV)-infected individuals with persistently normal serum ALT (PNALT) levels can suffer from severe liver fibrosis. Therefore, those patients can be prioritized in commencing the antiviral therapy. The timely diagnosis of liver fibrosis and initiation of anti-HBV treatment can control the disease progression and improve the patient prognosis. Serum ceruloplasmin (CP) is negatively correlated with liver fibrosis and thus it may serve as a predictive marker for liver fibrosis among HBV-infected individuals with PNALT.

Research motivation

Our previous data demonstrated that CP was negatively correlated with liver fibrosis in CHB individuals. Nonetheless, the association between CP and hepatic fibrosis among HBV-infected individuals with PNALT remains poorly understood.

Research objectives

We aimed to develop a predictive model combining serum CP to predict hepatic fibrosis among HBV-infected individuals with PNALT.

Research methods

Two hundred and seventy-five HBV-infected individuals with PNALT were retrospectively assessed between June 2010 and November 2019 from three affiliated hospitals of Fujian Medical University [First Affiliated Hospital, Mengchao Hepatobiliary Hospital, and The First Hospital of Quanzhou]. The association between CP and fibrotic stages was statistically analyzed. A predictive index that included CP was constructed to predict significant fibrosis and compared to previously established parameters like the aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), Fibrosis-4 score (FIB-4), gamma-glutamyl transpeptidase-to-PLT ratio (GPR), Forn’s score, and S-index.

Research results

We found that serum CP had an inverse correlation with liver fibrosis among HBV-infected individuals with PNALT. The CPHBV model was developed using CP, PLT, and HBsAg levels to predict various stages of fibrosis among HBV-infected individuals with PNALT. CPHBV was superior to previously reported models like APRI, FIB-4, GPR, Forn’s index, and S index.

Research conclusions

Serum CP is a routinely investigated biochemical parameter that negatively correlates with hepatic fibrosis and can be a potential marker to diagnose liver fibrosis in HBV-infected individuals with PNALT. The CPHBV model could accurately predict liver fibrosis in HBV-infected individuals with PNALT. Therefore, CPHBV may efficiently predict liver fibrosis, which can reduce the need for liver biopsy before commencing antiviral treatment.

Research perspectives

CPHBV was developed and evaluated in this multicenter cross-sectional study, thus providing a solid foundation for future prospective studies to validate the diagnostic value of this model.