Value of serum alpha-fetoprotein in predicting liver fibrosis in patients with chronic hepatitis B

Objective To investigate the correlation between serum alpha-fetoprotein ( AFP) and classification of liver fibrosis in patients with chronic hepatitis B ( CHB) , as well as the value of serum AFP in predicting liver fibrosis in CHB patients. Methods A total of 286 patients with a confirmed diagnosis of CHB who were hospitalized in our hospital from May 2015 to May 2017 were enrolled, and 150 healthy adults who underwent physical examination at the Physical Examination Center in our hospital from March 2016 to June 2017 and had qualified results were enrolled as healthy control group. Liver biopsy was performed for CHB patients, and related hematological parameters were measured, including platelet count ( PLT) , alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , albumin ( Alb) , globulin ( GLB) , alkaline phosphatase ( ALP) , gamma-glutamyl transpeptidase ( γ-GGT) , AFP, HBV DNA, and hepatitis B surface antigen ( HBs Ag) . The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; a Spearman correlation analysis was used to investigate the correlation between AFP and clinical indices; the receiver operating characteristic ( ROC) curve was used to evaluate the sensitivity and specificity of serum AFP level in predicting liver fibrosis. Results Of all 286 CHB patients, 19 had S0 liver fibrosis, 156 had S1 liver fibrosis, 52 had S2 liver fibrosis, 39 had S3 liver fibrosis, and 20 had S4 liver fibrosis; the Spearman correlation analysis showed that serum AFP level was positively correlated with the classification of liver fibrosis ( r = 0. 373, P < 0. 000 1) . There was a significant difference in serum AFP level between the CHB group and the healthy control group [2. 89 ( 1. 87-5. 59) ng/ml vs 2. 11 ( 1. 21-3. 10) ng/ml, P = 0. 0027]. There was also a significant difference in serum AFP level between the CHB patients with insignificant liver fibrosis and those with significant liver fibrosis [2. 51 ( 1. 70-3. 81) ng/ml vs 4. 17 ( 2. 42-14. 06) ng/ml, P = 0. 0069]. In CHB patients, serum AFP level was positively correlated with ALT ( r = 0. 393, P < 0. 000 1) , AST ( r = 0. 419, P < 0. 000 1) , and HBV DNA ( r = 0. 231, P < 0. 05) . There was no significant correlation between AFP level and HBs Ag ( r = 0. 154, P > 0. 05) . The correlation analysis showed that serum AFP level was positively correlated with aspartate aminotransferase-to-platelet ratio index in CHB patients ( r =0. 342, P < 0. 000 1) . The ROC curve was used to investigate the value of serum AFP level in predicting liver fibrosis, and the results showed that at the cut-off value of 3. 8 ng/ml, serum AFP level had a specificity of 84. 92%, a sensitivity of 37. 41%, and an area under the ROC curve of 0. 674 ( P < 0. 0001) , with a 95% confidence interval of 2. 03-8. 00 ng/ml. Conclusion In CHB patients, serum AFP level increases with the increase in liver fibrosis grade, and therefore, it has a good clinical value in evaluating significant liver fibrosis.