The relationship of the degree of hepatic fibrosis with hyaluronic acid, type 4 collagen, and procollagen type 3 N-terminal peptide levels in patients with chronic viral hepatitis

Abstract

Objective: To investigate the relationship of liver histopathology with the levels of noninvasive markers, namely hyaluronic acid (HA) type 4 collagen and procollagen 3 amino-terminal peptide (P3NP) used for the assessment of hepatic fibrosis in patients with chronic viral hepatitis.Materials and Methods: The study included 80 patients, 56 with chronic hepatitis B (CHB) and 24 with chronic hepatitis C (CHC) who presented to the outpatient clinic at Uludag University Faculty of Medicine, Department of Gastroenterology, and underwent pretreatment liver biopsy between 2008 and 2010. The patients were divided into 2 groups according to the degree of fibrosis: group 1 included patients with grade <= 3 fibrosis (no fibrosis, mild or moderate), group 2 included patients with grade >= 4 fibrosis (severe fibrosis). The association of hepatic fibrosis grade with HA, type 4 collagen, and P3NP was examined.Results: Among the 65 patients in group 1 whose fibrosis grade was confirmed via liver biopsy, 47 (72.3%) had HBV and 18 (27.7%) had HCV, whereas 9 of 15 (60%) in group 2 had HBV and 6 of 15 (40%) had HCV. There was no significant difference in the non-invasive fibrosis markers between the groups (p>0.05). In addition, there was not a significant difference in HA and P3NP levels between the CHB patients in groups 1 and 2 (p>0.05), but the type 4 collagen level was significantly higher in the HBV patients in group 2 (p<0.05). On the other hand, there were no significant differences in HA, type 4 collagen, and P3NP levels, or fibrosis grade between the HC patients (p>0.05).Conclusion: The use of any marker or combination of markers examined in the present study is not a substitute for liver biopsy for assessing hepatic fibrosis. The fibrosis markers examined in the present study could be further examined in research on anti-fibrotic treatment. Future clinical investigations are needed for the evaluation of the value of these tests in diagnosis and monitoring. It should not be forgotten that the basic diagnostic approach is liver biopsy.