LATENT COURSE OF LIVER FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS B: COMPARATIVE EVALUATION OF NONINVASIVE DIAGNOSTIC METHODS (APRI, FIB-4 AND FIBROSCAN)

Аннотация

Chronic hepatitis B (CHB) remains a significant global health burden, with liver fibrosis progression being a critical determinant of patient outcomes. Traditional liver biopsy, while considered the gold standard, carries inherent risks and limitations. This study evaluates the diagnostic accuracy and clinical utility of three noninvasive methods - APRI (AST-to-Platelet Ratio Index), FIB-4 (Fibrosis-4 Index), and FibroScan (transient elastography) - in assessing liver fibrosis progression in CHB patients. A prospective cohort study of 324 CHB patients was conducted over 24 months. All patients underwent simultaneous assessment using APRI, FIB-4, and FibroScan, with liver biopsy serving as the reference standard in 156 patients. Diagnostic performance was evaluated using ROC analysis, sensitivity, specificity, and predictive values. FibroScan demonstrated superior diagnostic accuracy for significant fibrosis (≥F2) with AUROC of 0.89 (95% CI: 0.85-0.93), followed by FIB-4 (AUROC: 0.81, 95% CI: 0.76-0.86) and APRI (AUROC: 0.76, 95% CI: 0.70-0.82). The combination of FibroScan with biochemical markers improved diagnostic accuracy to 0.92 (95% CI: 0.89-0.95). FibroScan exhibits superior performance in detecting liver fibrosis in CHB patients, while combining multiple noninvasive methods enhances diagnostic accuracy and may reduce the need for invasive liver biopsy.