How to check liver fibrosis and what indicators to look at

Liver fibrosis may lead to cirrhosis, so it deserves careful treatment. The onset of liver fibrosis is often accompanied by inflammation, which can cause liver damage or inability of the liver to function normally. Liver fibrosis can be identified through examination, and the examination method is relatively simple, so those who plan to go for a liver fibrosis examination do not need to worry too much.

First, biochemical tests: serum HA, LN, PCIII, and CIV can reflect the degree of liver fibrosis, especially HA and PCIII, which are the most valuable for early liver fibrosis.

HA (hyaluronidase): normal value <110mg/L. By comparison, the number of fibers formed in the liver and the degree of liver function damage can be accurately reflected. The HA index reflects the condition of the diseased liver more completely than liver biopsy and can be used as a sensitive indicator of liver fibrosis and cirrhosis.

LN (laminin): normal value <130ug/ml. By checking these four indicators, we can understand our condition as soon as possible. It is a non-collagenous structural protein unique to the basement membrane, which is positively correlated with portal vein pressure and the degree of liver fibrosis activity. It is significantly increased in cirrhosis, chronic liver disease and primary liver cancer. LN can reflect the progression trend of liver fibrosis. When LN levels increase, it means that esophageal varices become more obvious in patients with cirrhosis.

PCIII (type III procollagen): normal value <120ug/L. Liver fibrosis is a very dangerous disease and relevant examinations must be carried out. The serum content is correlated with the degree of liver fibrosis and has a significant relationship with the serum γ-globulin level, reflecting the synthesis of type III collagen in the liver. Continuous increase in PCIII is a sign of slow liver activity, warning that the condition has worsened and is developing into cirrhosis; PCIII drops to normal, indicating that the condition has improved. It can be seen that PCIII is not only valuable in the prognosis of chronic liver disease, but also meaningful in the early diagnosis of liver fibrosis.

IV-C (type IV collagen): normal value <75ug/L. The onset of liver fibrosis is relatively sensitive. It is also the main component of the basement membrane, reflecting the renewal rate of basement membrane collagen. The liver fibrosis process is relatively sensitive and is an important sign for judging liver fibrosis.

Secondly, imaging examination: B-ultrasound has a good correlation with the staging of liver fibrosis for five parameters including liver surface, liver echo, hepatic vein, liver margin and spleen area, but it is difficult to distinguish between stages 1 to 3; color Doppler ultrasound or radionuclide scanning can measure the blood flow of the hepatic artery and portal vein and the functional portosystemic shunt.

Again, pathological examination of liver biopsy: At this stage, pathological examination of liver biopsy is still the gold standard for diagnosing liver fibrosis. It is an important basis for clarifying the diagnosis, measuring the activity of inflammation, the degree of fibrosis, and determining the efficacy of drugs.

The average values ​​of FT were: F0=0.29; F1=0.29; F2=0.40; F3=0.53; F4=0.88 (Except for F0 and F1, the P values ​​among other groups were all <0.05). There was no statistical difference in HA between F2 and F1 or between F2 and F0. For the diagnosis of F4, the UROC (area under the ROC curves) of FT and HA were very high, 0.95 and 0.93, respectively. Myers et al. [8] studied 209 HBV patients, of whom 61 (29%) had fibrosis stages F2-F4, which could be accurately evaluated by FT (AUROC: 0.78±0.04).

The positive and negative predictive values ​​for liver fibrosis were both 92% for FT scores between ≤0.20 and >0.80. Therefore, it is believed that liver puncture is only needed for patients with FT>0.20 and ≤0.80 to clarify liver fibrosis and its extent. After reviewing 16 papers, Poynard pointed out that for patients with chronic HCV, FT and AT can replace liver puncture to evaluate liver fibrosis and inflammatory necrosis. Liver puncture should be used as the second line and only for those who are highly suspicious of FT and AT results.