Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters.

AIM To explore the grade and stage of pathology and the relationship between grading and staging of hepatic fibrosis and noninvasive diagnostic parameters. METHODS Inflammatory activity and fibrosis of consecutive liver biopsies from 200 patients with chronic liver disease were determined according to the Diagnostic Criteria of Chronic Hepatitis in China, 1995. A comparative analysis was made in these patients comparing serum markers, Doppler ultrasonography, CT and/or MR imaging with the findings of liver biopsy. RESULTS With increase of inflammatory activity, the degree of fibrosis also rose. There was a close correlation between liver fibrosis and inflammatory activity. AST, GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, N-terminal procollagen III(P III NP), collagen type IV(Col IV), tissue inhibitors of metalloproteinases-1 (TIMP-1), alpha-2-macroglobulin, natural killer cells(NK), some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the degree of inflammatory activity. GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, Col IV, TIMP-1, alpha-2- macroglobulin, transforming growth factor-beta 1 (TGFbeta1), NK, some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the staging of fibrosis. By regression analysis, the parameters used in combination to differentiate the presence or absence of fibrosis were age, GGT, the parameter of blood flow of portal vein per minute, the maximum oblique diameter of right liver by B ultrasound, the wavy hepatic surface contour by CT and/or MR. The sensitivity, specificity and accuracy of the above parameters were 80.36%, 86.67%, and 81.10%, respectively. CONCLUSION There is close correlation between liver fibrosis and inflammatory activity. The grading and staging of liver fibrosis are related to serum markers, Doppler ultrasonography, CT and/or MR imaging. The combination of the above mentioned noninvasive parameters are quite sensitive and specific in the diagnosis of hepatic fibrosis.

[1]  T. Murakami,et al.  Imaging evaluation of the cirrhotic liver. , 2001, Seminars in liver disease.

[2]  T. Poynard,et al.  Biochemical markers of liver fibrosis: a comparison with historical features in patients with chronic hepatitis C , 2002, American Journal of Gastroenterology.

[3]  E. J. van der Jagt,et al.  The value of Doppler ultrasound in cirrhosis and portal hypertension. , 1999, Scandinavian journal of gastroenterology. Supplement.

[4]  D. Hartmann,et al.  Serum laminin and type IV collagen are accurate markers of histologically severe alcoholic hepatitis in patients with cirrhosis. , 2000, Journal of hepatology.

[5]  P. Timms,et al.  Plasma Levels of Matrix Metalloproteinase-2 (MMP-2) and Tissue Inhibitors of Metalloproteinases-1 and -2 (TIMP-1 and TIMP-2) as Noninvasive Markers of Liver Disease in Chronic Hepatitis C Comparison Using ROC Analysis , 1999, Digestive Diseases and Sciences.

[6]  D. Conte,et al.  Severe liver fibrosis or cirrhosis: accuracy of US for detection--analysis of 300 cases. , 2003, Radiology.

[7]  T. Ripollés,et al.  Vascular imaging and interventional procedures in hepatic cirrhosis. , 2002, Seminars in ultrasound, CT, and MR.

[8]  P. Rampal,et al.  Non invasive prediction of severe fibrosis in patients with alcoholic liver disease. , 2000, Gastroenterologie clinique et biologique.

[9]  P. Schirmacher,et al.  Prediction of progressive liver fibrosis in hepatitis C infection by serum and tissue levels of transforming growth factor‐β , 2001, Journal of viral hepatitis.

[10]  H. Weng,et al.  Determination of serum fibrosis indexes in patients with chronic hepatitis and its significance. , 2003, Chinese medical journal.

[11]  P. Bedossa,et al.  Noninvasive diagnosis of hepatic fibrosis or cirrhosis. , 1997, Gastroenterology.

[12]  D. Crawford,et al.  Elevated serum type IV collagen: a sensitive indicator of the presence of cirrhosis in haemochromatosis. , 1999, Journal of hepatology.

[13]  O. Chazouilleres,et al.  Prognostic value of serum hyaluronan in patients with compensated HCV cirrhosis. , 2000, Journal of hepatology.

[14]  H. Kawasaki,et al.  Plasma transforming growth factor‐β1 concentrations in patients with chronic viral hepatitis , 1998, Journal of gastroenterology and hepatology.

[15]  R. Wachsberg,et al.  Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[16]  D Chappard,et al.  Histopathological evaluation of liver fibrosis: quantitative image analysis vs semi-quantitative scores. Comparison with serum markers. , 1998, Journal of hepatology.

[17]  E. Schiff,et al.  Measurement of serum hyaluronic acid in patients with chronic hepatitis C and its relationship to liver histology , 2000, Journal of gastroenterology and hepatology.

[18]  R. Testa,et al.  Validity and clinical utility of the aspartate aminotransferase-alanine aminotransferase ratio in assessing disease severity and prognosis in patients with hepatitis C virus-related chronic liver disease. , 2003, Archives of internal medicine.

[19]  E Testa,et al.  MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study , 2003, Gut.

[20]  R. Kalluri,et al.  Liver fibrosis: insights into migration of hepatic stellate cells in response to extracellular matrix and growth factors. , 2003, Gastroenterology.

[21]  G. Alexander,et al.  Serum hyaluronic acid is a useful marker of liver fibrosis in chronic hepatitis C virus infection , 1998, Journal of viral hepatitis.

[22]  P. Timms,et al.  Plasma tissue inhibitor of metalloproteinases-1 and transforming growth factor beta 1--possible non-invasive biomarkers of hepatic fibrosis in patients with chronic B and C hepatitis. , 2002, Hepato-gastroenterology.

[23]  Rong-hua Liu,et al.  ROC curves in evaluation of serum fibrosis indices for hepatic fibrosis. , 2002, World journal of gastroenterology.

[24]  H. Kawasaki,et al.  Diagnostic value of serum type IV collagen test in comparison with platelet count for predicting the fibrotic stage in patients with chronic hepatitis C , 2001, Journal of gastroenterology and hepatology.

[25]  P. Bedossa,et al.  Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. , 1999, Journal of hepatology.

[26]  E. Hahn,et al.  Doppler measurements: a surrogate marker of liver fibrosis? , 2002, European journal of gastroenterology & hepatology.

[27]  S. Torrubia,et al.  Doppler in hepatic cirrhosis and chronic hepatitis. , 2002, Seminars in ultrasound, CT, and MR.

[28]  D. Thabut,et al.  Noninvasive prediction of fibrosis in patients with chronic hepatitis C , 2003, Hepatology.

[29]  D. Schuppan,et al.  Serum Collagen Type VI and XIV and Hyaluronic Acid as Early Indicators for Altered Connective Tissue Turnover in Alcoholic Liver Disease , 2001, Digestive Diseases and Sciences.

[30]  G. De Sandre,et al.  Serum laminin and type III procollagen in chronic hepatitis C. Diagnostic value in the assessment of disease activity and fibrosis. , 1997, Clinica chimica acta; international journal of clinical chemistry.

[31]  M. Kasuga,et al.  Clinical significance of serum hyaluronic acid as a fibrosis marker in chronic hepatitis C patients treated with interferon‐α: Histological evaluation by a modified histological activity index scoring system , 1998, Journal of gastroenterology and hepatology.

[32]  H. Saisho,et al.  Serum Markers as Tools to Monitor Liver Fibrosis , 1998, Digestion.