[Hepatic fibrosis: physiopathology and biological diagnosis]

Hepatic fibrosis, of which cirrhosis is the most advanced stage, can result from any chronic liver disease due to any cause. Normal extracellular matrix components accumulate in the liver as a result of imbalances in their production, deposition, and breakdown. These matrix components are produced primarily by myofibroblastic hepatic cells whose main cellular source in the liver is the stellate cell (Ito cell). Histopathological examination of a liver biopsy specimen is currently the gold-standard investigation for estimating the severity of fibrosis in patients with chronic liver disease. However, the recent development of treatments with activity against the fibrosing process requires evaluation of fibrosis at closely spaced intervals and, therefore, the development of tests that do not require a liver biopsy. Advances in our understanding of the mechanisms underlying hepatic fibrogenesis have allowed to identify several substances of potential clinical usefulness. Serum assays of extracellular matrix components, their breakdown products, or enzymes involved in their metabolism have been suggested for the noninvasive evaluation of hepatic fibrosis. Clinical studies have shown that serum hyaluronate is to date the marker with the closest correlations to hepatic fibrosis and the noninvasive parameter with the highest sensitivity for cirrhosis.