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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B
Chang-Feng Dong, Jia Xiao, Ling-Bo Shan, Han-Ying Li, Yong-Jia Xiong, Gui-Lin Yang, Jing Liu, Si-Min Yao, Sha-Xi Li, Xiao-Hua Le, Jing Yuan, Bo-Ping Zhou, George L Tipoe, Ying-Xia Liu
Chang-Feng Dong, Han-Ying Li, Division of Ultrasound, Shenzhen Third People’s Hospital, Shenzhen 518112, China
Jia Xiao, Ling-Bo Shan, Gui-Lin Yang, Jing Liu, Si-Min Yao, Sha-Xi Li, Jing Yuan, Bo-Ping Zhou, Ying-Xia Liu, National Key Disciplines for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen 518112, China
Jia Xiao, Yong-Jia Xiong, Department of Immunobiology, Institute of Tissue Transplantation and Immunology, Jinan University, Guangzhou 510632, Guangdong Province, China
Xiao-Hua Le, Department of Pathology, Shenzhen Third People’s Hospital, Shenzhen 518112, China
George L Tipoe, School of Biomedical Sciences, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
Author contributions: Xiao J, Li HY and Liu YX are the guarantors of integrity of entire study; all authors contributed to study concepts/study design or data acquisition or data analysis/interpretation; all authors contributed to manuscript drafting or manuscript revision for important intellectual content; all authors gave approval of final version of submitted manuscript; Dong CF, Shan LB, Yang GL, Liu J, Yao SM, Le XH, Yuan J and Liu YX contributed to clinical studies; Dong CF, Li HY, Xiong YJ, Li SX and Liu YX contributed to statistical analysis; Dong CF, Xiao J, Xiong YJ, Zhou BP, Tipoe GL and Liu YX contributed to manuscript editing; Dong CF, Xiao J and Shan LB contributed equally to this work.
Supported by Shenzhen Municipal Science and Technology Innovation Fund, Nos. CXZZ20130322170220544 and JCYJ20140411112047885.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee Office of Shenzhen Third People’s Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
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: George L Tipoe, MD, PhD, School of Biomedical Sciences, LKS Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong, China.
tgeorge@hku.hk
Telephone: +852-39179185
Received: January 8, 2016
Peer-review started: January 8, 2016
First decision: February 26, 2016
Revised: March 8, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: May 18, 2016
Processing time: 125 Days and 2 Hours
AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B (CHB).
METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated.
RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage (all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI (P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage (Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI (Z = 0.958, P = 0.338).
CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.
Core tip: Chronic hepatitis B (CHB) is a major health problem in a lot of countries all over the world, particularly in China. An accurate staging of liver fibrosis is critical for prognosticating this disease. However, although it is still the golden standard, liver biopsy is hindered by its inherent drawbacks in clinical applications. In this study, we demonstrated that non-invasive methods, including acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index showed significant correlations with the histological staging results from liver biopsy. The combined measurement of ARFI and APRI had the best diagnostic accuracy, which provided an ideal and convenient non-invasive diagnostic method for the detection of hepatic fibrosis of CHB patients in clinical practice.
