[Accuracy of FibroScan for the diagnosis of liver fibrosis influenced by serum alanine aminotransferase levels in patients with chronic hepatitis B].

OBJECTIVE: To analyze whether or not the accuracy of liver stiffness measurement (LSM) with transient elastography (FibroScan) for the diagnosis of liver fibrosis influenced by serum alanine aminotransferase (ALT) levels in patients with chronic hepatitis B.

METHODS: 213 consecutive CHB patients who underwent liver biopsy and LSM were enrolled and divided into three groups by the criteria of ALT < 1 x ULN, 1 x ULN ≤ ALT < 2 x ULN and ALT ≥ 2 x ULN. The areas under the receiver operating curve(AUC) were analyzed and the accuracy of FibroScan for the diagnosis of liver fibrosis were detected in the three groups.

RESULTS: Significant correlation existed between the stages of liver fibrosis and LSM (rs = 0.773, 0.889 and 0.412, P < 0.05). AUCs of LSM in all patients for significant fibrosis (F ≥ 2, F0-1 vs F2-4) and cirrhosis (F = 4, F0-3 vs F4) were 0.916 and 0.971 respectively. The accuracy of diagnosis for significant fibrosis and cirrhosis were 84.0% and 93.4% respectively. AUCs of LSM in ALT < 1 x ULN, 1 x ULN ≤ ALT < 2 x ULN and ALT ≥ 2 x ULN groups for significant fibrosis were 0.939, 0.967 and 0.687 respectively. The sensitivity of the three groups was 90.0%, 89.7% and 47.8% respectively. The accuracies of the three groups was 90.5%, 93.9% and 68.4% respectively. The AUC, sensitivity and accuracy of ALT ≥ 2 x ULN group for significant fibrosis were significantly lower than the other two groups. AUCs of LSM in three groups for cirrhosis were 0.970, 0.985 and 0.952 respectively. The sensitivities of the three groups were 93.8%, 100% and 100% respectively. The accuracies of the three groups were 88.9%, 95.9% and 92.1% respectively. The AUCs, sensitivity and accuracy for cirrhosis of the three groups didn't change with elevated ALT.

CONCLUSIONS: Transient elastography (FibroScan) is a reasonable noninvasive tool to diagnose significant fibrosis, especially liver cirrhosis in CHB patients. The accuracy of FibroScan for diagnosis of liver cirrhosis may not be influenced by elevated ALT. While in ALT ≥ 2 x ULN group, the accuracy of FibroScan for diagnosis of significant fibrosis was significantly lower as compared to the ALT ≤ 2 x ULN groups.