Abstract
BackgroundWisteria floribunda agglutinin-positive Mac-2-binding protein (WFA+-M2BP) was a novel marker of liver fibrosis. We aimed to investigate WFA+-M2BP level in assessing liver fibrosis in patients with chronic hepatitis B (CHB) infection.MethodsA total of 160 CHB patients, who received a liver biopsy, were consecutively recruited. Serum WFA+-M2BP level was quantified at the time point of biopsy. The results were compared with histopathological manifestations and clinical characteristics of the patients.ResultsThe median WFA+-M2BP level, aspartate aminotransferase-to-platelet ratio (APRI) and Fibrosis-4 (FIB-4) index were 1.20 COI, 1.19, and 1.63, respectively. Fifty-one (31.9%) patients had advanced fibrosis. There was a significant increase of WFA+-M2BP levels in parallel to necroinflammation/fibrosis stages. The areas under the receiver operating characteristic curve (AUROC) of WFA+-M2BP level for predicting fibrosis stages were 0.780 of F2, 0.785 of F3, and 0.769 of F4, respectively (all p <0.001). The multivariate analysis identified age (Odds ratio [OR] 1.05, 95% confidence interval [CI]: 1.010–1.092, p = 0.014), platelet (OR: 0.99, 95%CI: 0.980–0.998, p = 0.013), and WFA+-M2BP level (OR: 1.97, 95% CI: 1.299–2.984, p = 0.001) as independent factors associated with advanced fibrosis. Combination of age, platelet and WFA+-M2BP level achieved a better diagnostic performance for advanced fibrosis (AUROC: 0.732, accuracy: 81.3%) than APRI (AUROC: 0.577, accuracy: 63.8%) or FIB-4 index (AUROC: 0.691, accuracy: 75.6%).ConclusionWFA+-M2BP had a good performance indistinguishing liver fibrosis in CHB patients. The combination of age, platelet, and WFA+-M2BPaddressed more accuracy in identifying patients with advanced fibrosis.
Highlights
The multivariate analysis identified age (Odds ratio [OR] 1.05, 95% confidence interval [CI]: 1.010–1.092, p = 0.014), platelet (OR: 0.99, 95%CI: 0.980–0.998, p = 0.013), and WFA+-M2BP level (OR: 1.97, 95% CI: 1.299–2.984, p = 0.001) as independent factors associated with advanced fibrosis
Hepatitis B virus (HBV) infection remained the leading cause of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) worldwide, especially in the Asia-Pacific region.[1]HBV viral load, hepatitis B e antigen (HBeAg) and liver fibrosis severity were associated with the development of LC and HCC in patients with chronic HBV infection (CHB).[2,3]
Significant fibrosis development is an important checkpoint during fibrogenesis, and which implies that antiviral therapy should be implemented.[8]Liver biopsy is the current gold standard to assess the severity of necroinflammation and fibrosis.[9]
Summary
Hepatitis B virus (HBV) infection remained the leading cause of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) worldwide, especially in the Asia-Pacific region.[1]HBV viral load, hepatitis B e antigen (HBeAg) and liver fibrosis severity were associated with the development of LC and HCC in patients with chronic HBV infection (CHB).[2,3] With long-term HBV antiviral therapy, nucleos(t)ide analogs, the risk of LC and HCC decreased and regression of fibrosis was achieved.[4,5]The current regional guidelines recommended HBV antiviral therapy in patients with high HBV viral load with significant fibrosis (Metavir F2), even the alanine aminotransferase (ALT) level was below the 2-fold upper limit of normal (ULN).[6,7]disease severity assessment, namely fibrosis staging, is essentialin the decision-making of antiviral therapy as well as complication evaluation in a clinical setting.Fibrosis development is a subtle process during the natural course of CHB. The predictive value in CHB remained uncertain.[12,13] Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA+-M2BP), a product released during fibrogenesis process, was recently developed as a novel serological marker of liver fibrosis.[14,15]Recent studies demonstrated a significant association between serum WFA+-M2BP level and severity of liver fibrosis in subjects with hepatitis C virus infection and non-alcoholic steatohepatitis.[16,17,18] The comparison of WFA+-M2BPand directly fibrosis assessment, Fibroscan, had been studied. In the recent study investigating a large scale of chronic hepatitis C patients, the authors demonstrated that serum WFA+-M2BP was superior to other non-invasive markers in the prediction of significant fibrosis and had the greatest specificity in the diagnosis of cirrhosis.[19]In addition, the serum WFA+-M2BP level could predict the development of liver-related events, including the occurrence of decompensation and the development of HCC.[16,20,21]application of WFA+-M2BP level in assessing liverfibrosis has rarely been investigatedin CHB patients. Editor: Tatsuo Kanda, Nihon University School of Medicine, JAPAN Received: April 16, 2019 Accepted: July 20, 2019 Published: August 8, 2019
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