Comparison of diagnostic informative value of the methods for the determination of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Rithis coefficient) of liver fibrosis markers in patients with chronic viral hepatitis C

Abstract

The results of chronic viral hepatitis C patients examinations are described. A comparative characteristic of the diagnostic informative value of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Ritis coefficient) of liver fibrosis markers by the use of ROC - analysis is presented. The objective: to explore the possibility of non-invasive methods for diagnosing liver fibrosis in patients with chronic viral hepatitis C (CVH C). Materials and methods. 66 CVH C with the 1st genotype of the virus were examined. They were either at dispensary observation or ambulatory treatment at Municipal Clinical Hospital №1 (Vinnitsa, Ukraine) and in the clinical department of viral hepatitis at L. V. Gromashevsky Institute of Epidemiology and Infectious Diseases of NAMS (Ukraine). All patients underwent fibroelastography (FEG) on the METAVIR fibrosis score. In all CVH C patients and control group individuals content of hyaluronic acid (HA) in blood serum was determined. ELISA method and “Hyaluronic Acid” kit (Corgenix, Inc., USA) were used. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity was investigated with kinetic method (analyzer and test system Cobas 6000, Roche Diagnostics, Switzerland). Results: AUC for HA content in serum of CVH C patients was in the range 0.720-0.917 (p<0.01). Signs of the cytolytic syndrome were recorded in 86.4% of the patients under examination. AUC for determining the value of ALT in serum in СVH С patients with liver fibrosis F0-F2 and F4 was less than 0.5. Sensitivity and specificity of blood serum ALT determination in the patients under study by the degree of liver fibrosis F3 were respectively 97.71% and 96,42% (AUC = 0.906; p <0.001). The method of determining the value of AST in serum of patients with CVH with fibrosis degree F0-F2 also has a low informativity (AUC<0.5). However, in the group of patients with F3 liver fibrosis, the sensitivity of this method (determination of AST) was 83.51% and specificity was 82.12% (AUC = 0.809, p = 0.0428). The sensitivity and specificity of determining the serum AST value in patients with F4 fibroblasts was 78.23% and 75.25%, respectively (AUC = 0.817 (p = 0.011), were found to be slightly lower). Conclusions. High diagnostic informative value of the determination of the content of HA in serum was established for assessing the degree of liver fibrosis in patients with CVH C (AUC = 0.720 – 0.17, p<0,01). High diagnostic informativity for the method of determining the value of ALT in CVH C patients is only established in patients with F3 hepatic fibrosis (AUC = 0.906 (p <0.001)). For the method of determining the value of AST in CVH C patients, statistically reliable diagnostic informative data was established for patients F3 hepatic fibrosis grade (AUC = 0.809, p = 0.042) and F4 (AUC = 0.817, p = 0.011). Diagnostically significant informative of the method under discussion for determining the value of dRk in CVH C patients has been established in F3 hepatic fibrosis: AUC = 0.928 (p = 0,033).