|
Evaluation of Serum
Hyaluronic Acid and APRI Score as Non Invasive Indicators for Liver
Fibrosis in Chronic HCV
Mahmoud Anees(1),
Ahmed Farrag(1), Galal El Kassas(1) & Ehab
Nayel(2)
Departments of Tropical Medicine(1) & Clinical Pathology(2),
Faculty of Medicine, Tanta University, Egypt.
Tanta Med. Sc. J 2008; 3(4):62-69
Article type: Original article
Background/Aim: Determination of the
histopathological status of liver in patients with chronic hepatitis
C (CHC) is an important inclusion criterion for antiviral therapy.
Liver biopsy is sometimes risky and has important limitations
including sampling errors and interobserver variability.
Determination of the stage of fibrotic process requires accurate and
specific diagnostic parameters of liver fibrosis. These include
serum hyaluronic acid, Gamma-glutamyltransferase (GGT), aspartate
aminotraferase (AST)/alanine aminotrasferase (ALT) ratio and the AST
to Platelet Ratio Index (APRI). The present study aimed at
evaluation of some non invasive methods; serum hyaluronic acid, GGT,
AST/ALT ratio and APRI test versus liver biopsy as non invasive
indicators of liver fibrosis in cases of chronic HCV infection.
Patients & Methods: The study was conducted on 42 patients (28 males
and 14 females) with chronic HCV infection, confirmed by the
positivity of PCR for HCV RNA. The age ranged from 21 to 57 years
(44.8 years ± 14.8). All cases had had recent liver biopsy (with
grading using Metavir score) before taking the decision of
interferon therapy. All cases were subjected to history taking,
thorough clinical examination and routine laboratory investigations
with special emphasis on ALT, AST, platelets, GGT and measurement of
serum hyaluronic acid, APRI score (AST to Platelet Ratio Index).
Results: For fibrosis stages F0, F1-F2, and F3-F4, serum hyaluronic
acid was 86.3 ± 13.5, 57.4 ± 10.2, 233.4 ± 30.9 ng/mL respectively.
For stages F0, F1, F2, F3 and F4, APRI score was 0.57 ±0.58, 1.003
±0.16, 1.12 ± 1.8, 1.37 ± 1.2 and 1.64 ± 1.43 respectively. GGT was
67.12 ±10.58, 56.4 ±20.1, 67.12 ±16.3, 81.8±12.5 and 78.1±22.1
respectively. AST/ALT was 0.5 ±0.02, 0.75 ±0.04, 0.63 ±0.03, 0.81
±0.07 and 1.08 ± 0.05 respectively. Only APRI score and AST/ALT
showed correlation with stage of fibrosis. As a diagnostic tool for
extensive fibrosis and cirrhosis, AST/ALT had sensitivity and
specificity of 42%, 88% respectively. APRI score was 90% and 87%.
GGT was 91% and 23%. Hyaluronic acid was 85% and 82%. Conclusion:
Among the parameters investigated in this study, on selecting a
single non-invasive parameter for diagnosis of stage of fibrosis in
CHC patients, serum hyaluronic acid was helpful only to prove or
exclude advanced fibrosis and cirrhosis, while the APRI score showed
the best correlation with fibrosis of the liver, and it depends on
routine available non expensive parameters. A combination of these
tests may be promising.
ICID 881850 |