[Serum fibrosis markers in diagnosing liver fibrosis]

To evaluate the clinical value of serum fibrosis markers hyaluronic acid (HA), type IV collagen (CIV), type III procollagen N peptide (PIIIP) and laminin (LN) in the diagnosis of liver fibrosis.

Detection of the serum levels of these markers including HA, CIV, PIIIP, LN was carried out in 50 patients with chronic hepatitis B and 18 healthy persons. Liver biopsy was performed in all patients. The relationship between the markers and liver fibrosis stage was analyzed and the diagnostic value of the markers in liver fibrosis stage evaluated with receiver operating curve.

The correlation between serum HA, CIV, PIIIP and histologically assessed grade of inflammatory activity was weak (r = 0.430, 0.382 and 0.300, respectively, P < 0.05). The correlation between serum HA, CIV and histologically assessed stage of liver fibrosis were moderate (r = 0.614, 0.708, respectively, P < 0.05). The increase in serum HA, CIV was correlated with the progression of liver fibrosis. Based on receiver operating curve, the value of using serum HA to differentiate patients with early cirrhosis (S4) from those without cirrhosis (S0-S3) was greater than that of serum CIV, PIIIP and LN (the areas under the curves = 0.967 vs 0.932, 0.659, 0.403), while the ability of serum CIV to predict liver fibrosis (S1-S4) was superior to that of serum HA, PIIIP and LN (areas under the curves = 0.853 vs 0.680, 0.536, 0.487). Serum LN was found to show limited changes in different pathologic grade and stage. The combined detection of HA and CIV has higher specificity than that of a single marker.

Serum fibrosis markers can be helpful in diagnosis of liver fibrosis even in its early stage, but can not discriminate accurately the stage of fibrosis as accurately as the histological assessment. The combination of fibrosis markers is more valuable than single marker. New fibrosis markers and combination of noninvasive markers are the future trend in liver fibrosis research.