[Accurate diagnosis of stages of hepatic fibrosis by measuring levels of serum hyaluronic acid, procollagen type III, and collagen type IV].

OBJECTIVE: To study the accurate diagnosis of various stages of hepatic fibrosis by measuring serum hyaluronic acid (HA), procollagen type III (PC III), and collagen type IV (CIV). METHODS: The concentrations of serum HA, PC III, CIV in 253 patients with chronic liver disease were measured by radioimmunoassay. Liver biopsies were performed in all of the patients at the same time. According to the results of liver pathological diagnosis, we assessed the ability of serum HA, PC III and CIV to identify correctly patients with hepatic fibrosis (staging >or=S(2)) or cirrhosis (S(4)). RESULTS: The cutoff value of HA, PC III and C IV to identify correctly patients with hepatic fibrosis was 90 microg/L, 90 microg/L, 75 microg/L respectively. The sensitivity (Se) was 80.4%, 82%, 63.1%; the specificity (Spe) was 70.2%, 60.8%, 83.8%; the positive prediction value (PPV) was 86.7%, 83.5%, 90.4%; the negative prediction value (NPV) was 59.8%, 58.4%, 48.4%, respectively. The cutoff value to identify patients with cirrhosis was: HA 210 microg/L, Se 96.2%, Spe 85.3%, PPV 65.4%, NPV 98.8%; PC III 150 microg/L, Se 76.4%, Spe 68.7%, PPV 40.4%, NPV 91.3%; C IV 90 microg/L, Se 80%, Spe 75.8%, PPV 47.8%, NPV 93.2%, respectively. CONCLUSIONS: The determination of serum HA, PC III and C IV can make relatively accurate diagnosis to various stages of hepatic fibrosis. HA is the best for diagnosis of liver cirrhosis.