Diagnostic value of serum fibrosis markers [hyaluronic acid and matrix metaloproteinase-2] as a marker of hepatic fibrosis

ABSTRACT

Several biochemical markers have shown promise for the detection of advanced fibrosis and cirrhosis. The aim of the present work is to study the diagnostic accuracy of serum hyaluronic acid [SHA] and matrix metaloproteinase-2 [MMP-2] as indicators for the stages of hepatic fibrosis, and to correlate the liver pathology and liver function tests with serum fibrosis markers. Sixty treatment naive patients with chronic liver disease [30 with chronic hepatitis C [CHC] with or without HBV and 30 patients with cirrhosis]. The patients were divided according to Metavir classification of liver biopsy into 3 groups. Group 1 with normal biopsy [12 patients], group 2 -25 patients with mild fibrotic changes [stage 1-2] and group 3 of 23 patients with severe fibrosis [stage 3-4]. SHA level was significantly higher in patients with severe fibrosis than patients with mild or no hepatic fibrosis [378.7 +/- 147.5, 226.2 +/- 123.7and 85.3 +/- 52.2 pg/ml]. [P<0.0001]. MMP-2 was also significantly higher in severe fibrosis [group 3] than gr2 or gr1 [1196.2 +/- 119.5, 918.1 +/- 175.8 and 841.1 +/- 224.5 pg/ml] respectively [P<0.001]. SHA and MMP-2 were not correlated to age, S bilirubin, AST, ALT or spleen size. Group 3 was correlated significantly to the SHA and MMP, platelet count, S albumin and liver size but not correlated to AST, ALT, S. bilirubin or spleen size. The specificity of fibrosis markers SHA and MMP-2 in prediction of severe fibrosis were 94.4% and 90.0% respectively and the sensitivity were higher to SHA 90% than MMP-2 80% but not a predictor of mild or normal biopsy. The cut of value of SHA, MMP-2, platelet count and prothrombin time [PT], in diagnosis of severe fibrosis were 294.84 pg/ml., 1003 pg/ml., 115.084/cmm, 72.116% respectively. Measurement of SHA and MMP-2 can be used to differentiate cirrhotic from non-cirrhotic patient and can be regarded as a useful test in the diagnosis of liver cirrhosis