Objective To investigate the correlation between routine laboratory indicators and the severity of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection. Methods This retrospective study analyzed clinical data from 202 patients with chronic HBV infection who were admitted to the Department of Infectious Diseases at Maoming Clinical Medical College, Affiliated Hospital of Guangdong Medical University, between January 2023 and December 2023. Based on liver stiffness measurement (LSM) values, patients were categorized into fibrosis stages F0-F1(n=84), F2(n=56), F3(n=48), and F4(n=14). Routine blood, coagulation, and liver function indicators were measured and their correlations with liver fibrosis severity were analyzed. Receiver operating characteristic (ROC) curves were used to assess the predictive value of individual and combined indicators in evaluating fibrosis severity, and diagnostic thresholds and area under the curve (AUC) values were determined. Results With the progression of liver fibrosis, levels of platelet count (PLT), prothrombin activity (PTA), albumin (ALB), and cholinesterase (CHE) gradually decreased, reaching their lowest levels at stage F4. In contrast, levels of total bile acid to platelet ratio (TRP), AST-to-platelet ratio index (APRI), total bilirubin (TBIL), direct bilirubin (DBIL), and gamma-glutamyl transferase (GGT) increased with fibrosis stage. Pearson correlation analysis showed that TRP, APRI, TBIL, DBIL, and globulin (GLB) were positively correlated with fibrosis severity, while PLT was negatively correlated. ROC curve analysis revealed that the combination of 13 routine indicators yielded an AUC of 0.930, with a sensitivity of 0.894 and a specificity of 0.923, significantly outperforming any single indicator, indicating high predictive value for the combined assessment. Conclusion Routine laboratory indicators—including blood counts, liver function, and coagulation parameters—are closely associated with the severity of liver fibrosis in patients with chronic HBV infection. Among them, PLT shows the most significant decline in advanced fibrosis. The combined use of indicators such as TRP and APRI can effectively improve the accuracy of fibrosis prediction and holds significant clinical utility.
Key words
chronic hepatitis b virus infection /
platelet count /
liver fibrosis severity /
correlation
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References
[1] 刘力进, 漆琪, 李银乔, 等.2020年四川省1-14岁儿童乙型肝炎表面抗原血清流行率和影响因素[J]. 中国疫苗和免疫, 2022, 28(5): 540-543.
[2] LEBDA M A, SADEK K M, ABOUZED T K, et al.Melatonin mitigates thioacetamide-induced hepatic fibrosis via antioxidant activity and modulation of proinflammatory cytokines and fibrogenic genes[J]. Life Sci, 2018, 192: 136-143.
[3] LEE C M, YOON E L, KIM M, et al.Prevalence, distribution, and hepatic fibrosis burden of the different subtypes of steatotic liver disease in primary care settings[J]. Hepatology, 2023, 79(6): 1393-1400.
[4] Ozaki T, Kawashita E, Ishihara K, et al.Deficiency of group IVA phospholipase A2 in collagen-producing cells alleviates the aggravated hepatic fibrosis in high-fat diet-fed mice after returning to a normal diet[J]. Biol Pharm Bull, 2023, 46(3): 488-493.
[5] Kumar S, Duan Q, Wu R, et al.Pathophysiological Communication between Hepatocytes and Non-Parenchymal Cells in Liver Injury from NAFLD to Liver Fibrosis[J]. Adv Drug Deliv Rev, 2021, 176(1999-2014): 1138-1145.
[6] SHROPSHIRE S B, OLVER C S, TWEDT D C, et al.Multiplate platelet aggregometry in dogs undergoing laparoscopic liver biopsy for diagnosis of chronic hepatopathy[J]. J Small Anim Pract, 2022, 63(5): 389-396.
[7] KASAHARA N, IMI Y, AMANO R, et al.A gut microbial metabolite of linoleic acid ameliorates liver fibrosis by inhibiting TGF-β signaling in hepatic stellate cells[J]. Sci Rep, 2023, 13(1): 1898-1908.
[8] MERITSI A, LATSOU D, TSORLALIS I, et al.Blood based biomarkers as non-invasive screening tools for hepatic fibrosis in subjects with Type 2 Diabetes Mellitus[J]. Metabolism, 2022, 128(69): 1549-1557.
[9] BADAWY M, ABDELSALAM O, KHATAN A M, et al.Effect of preoperative platelet count on liver resection for hepatocellular carcinoma[J]. The Egyptian Journal of Surgery, 2022, 41(35): 837-846.
[10] 赵景, 何秀波, 谌瑾寰. 肝脏剪切波弹性成像联合GGT/PLT比值诊断慢性乙型肝炎患者肝纤维化价值研究[J]. 实用肝脏病杂志, 2023, 26(3): 332-335.
[11] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南 (2019年版)[J]. 肝脏, 2019, 24(12): 1335-1356.
[12] 中华医学会传染病与寄生虫病学分会, 肝病学分会. 病毒性肝炎防治方案[J]. 中华传染病杂志, 2001, 19(1): 56-62. . 病毒性肝炎防治方案[J]. 中华传染病杂志, 2001, 19(1): 56-62. http://doi.10.3760/j.issn:1000-6680.2001.01.027.
[13] Malden D E, Wong R J, Chitnis A S, et al. Screening Practices and Risk Factors for Co-Infection with Latent Tuberculosis and Hepatitis B Virus in an Integrated Healthcare System — California, 2008-2019[J]. Am J Med, 2024, 137(3): 258-265. e3.
[14] ISMAIL A, IMAM M, GHARIB K .Warts as a Therapeutic Dilemma; Different Therapies with focus on Intralesional Acyclovir and Intralesional Hepatitis-b Virus Vaccine[J]. Zagazig University Medical Journal, 2023, 30(1): 262-270.
[15] ARSHAD T, VAINER D, KHAN H, et al.Development of Clinical Algorithm Utilizing Vibration-Controlled Transient Elastography to Detect Advanced Hepatic Fibrosis in Liver Transplant Recipients[J]. Dig Dis Sci, 2024, 69(5): 1844-1851.
[16] YEILTA M, AK H, OZSAHIN Y, et al.The Effect of Postoperative Hepatic Fibrosis Factors on Morbidity in Mitral Valve Replacement Surgery: A Single Center Ten Years’ Experience[J]. Ann Card Anaesth, 2023, 26(19): 190-196.
[17] SAMYN M, INDOLFI G, VERGANI D, et al.Liver Biopsy is Indicated Before Attempting Treatment Withdrawal in Children with AIH: Commentary by the ESPGHAN HepCom.[J]. J Pediatr Gastroenterol Nutr, 2023, 77(3): 63-64.
[18] CHEN TB, JIANG JW, GUO HY, et al.Causal relationship between hepatic function indicators and thrombocytopenia risk in early-stage hepatitis B virus infection: evidence from clinical observational studies and mendelian randomization analyses[J]. Front Immunol, 2025, 16: 1440317.
[19] LEI F, LIU YM, ZHOU F, et al.Longitudinal association between markers of liver injury and mortality in COVID‐19 in China[J]. Hepatology, 2020, 72(2): 389-398.
[20] ABBASI M, ANZALI B C, MEHRYAR H R.Liver enzymes as a predictor of mortality in patients with COVID-19? A cross-sectional study[J]. Toxicol Rep, 2024, 12: 266-270.
[21] 卢晶, 朴红心, 金雪梅, 等. 慢性乙型肝炎肝纤维化抗病毒治疗后生活质量与AST/PLT比率、肝硬度值、病理组织学的相关性分析[J]. 临床肝胆病杂志, 2021, 37(4): 813-816.
[22] LEE H A, JUNG J Y, LEE Y S, et al.Direct bilirubin is more valuable than total bilirubin for predicting prognosis in patients with liver cirrhosis[J]. Gut Liver, 2020, 15(4): 599.
[23] CHEN L W, HUANG M S, SHYU Y C, et al.Gamma-glutamyl transpeptidase elevation is associated with metabolic syndrome, hepatic steatosis, and fibrosis in patients with nonalcoholic fatty liver disease: A community-based cross-sectional study[J]. Kaohsiung J Med Sci, 2021, 37(9): 819-827.
[24] SURANA P, HERCUN J, TAKYAR V, et al.Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis[J]. World J Gastrointest Pathophysiol, 2021, 12(3): 40-50.
[25] KIM H J, KIM S Y, KWON G C, et al.Detecting spread of SARS-CoV-2 variants using PowerChek SARS-CoV-2 S-gene mutation detection kit[J]. J Clin Lab Anal, 2022, 36(8): e24567.
[26] WHITFIELD J B.Gamma glutamyl transferase[J]. Crit Rev Clin Lab Sci, 2001, 38(4): 263-355.
[27] 王栋, 居峰, 姚上志, 等. 白细胞介素-34、血小板 、谷氨酰转肽酶及白蛋白和球蛋白的比值联合诊断模型评估慢性乙型肝炎肝纤维化的价值[J]. 国际消化病杂志, 2018, 38(5): 320-326.
[28] 蔡峻岭, 苏立, 郝丽, 等. 慢性乙型肝炎肝硬化患者LN、CHE及TRF表达水平与病情的关系[J]. 分子诊断与治疗杂志, 2024, 16(4): 739-742.
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