Serum surrogate markers of liver fibrosis in primary biliary cirrhosis.
BACKGROUND
Hyaluronan, leptin, laminin and collagen IV have been used extensively for the assessment of liver fibrosis. The aim of this study was to assay these markers in the peripheral and hepatic vein blood of primary biliary cirrhosis (PBC) patients and to study their ability to discriminate early from advanced disease.


METHODS
Sera from 62 PBC patients were compared to 60 controls, 44 chronic Hepatitis C, 38 hepatocellular carcinoma and 34 viral cirrhosis patients. Serum from the hepatic vein of 15 cirrhotic PBC patients and 17 patients with viral cirrhosis was also assayed.


RESULTS
All disease groups had significantly increased levels of hyaluronan and collagen IV, compared to controls, while laminin was significantly increased only in viral cirrhosis. Hyaluronan levels were statistically different between early (54.5 ng/ml; 95%CI 27.3-426.9) and late PBC (154.5 ng/ml; 95%CI 55.3-764.4, p<0.05). The area under the curve (AUC) for the identification of late PBC was 0.74 for hyaluronan, 0.63 for leptin, 0.59 for laminin and 0.70 for collagen IV. Hyaluronan had high sensitivity and NPV in identifying late stages of PBC (96% and 90%, respectively). Short term UDCA had no effect on these markers.


CONCLUSIONS
No single measurement can differentiate between advanced and early fibrosis in PBC. However serum hyaluronan is a promising single serum marker for longitudinal studies in PBC.
University Hospital Department of Gastroenterology, University of Crete, Faculty of Medicine, Heraklion, 71100, Crete, Greece.
Argiro
A
Voumvouraki
Mairi
M
Koulentaki
George
G
Notas
Ourania
O
Sfakianaki
Elias
E
Kouroumalis
D000276:Adjuvants, Immunologic / Q000097:blood*; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood; D016022:Case-Control Studies; D024141:Collagen Type IV / Q000097:blood*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007797:Laminin / Q000097:blood*; D020738:Leptin / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis; D008105:Liver Cirrhosis, Biliary / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D000276:Adjuvants, Immunologic; D015415:Biomarkers; D024141:Collagen Type IV; D007797:Laminin; D020738:Leptin; D006820:Hyaluronic Acid