Clinical Research
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 15, 2003; 9(11): 2574-2578
Published online Nov 15, 2003. doi: 10.3748/wjg.v9.i11.2574
Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters
Lun-Gen Lu, Min-De Zeng, Mo-Bin Wan, Cheng-Zhong Li, Yi-Min Mao, Ji-Qiang Li, De-Kai Qiu, Ai-Ping Cao, Jun Ye, Xiong Cai, Cheng-Wei Chen, Ji-Yao Wang, Shan-Ming Wu, Jin-Shui Zhu, Xia-Qiu Zhou
Lun-Gen Lu, Min-De Zeng, Yi-Min Mao, Ji-Qiang Li, De-Kai Qiu, Ai-Ping Cao, Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China
Mo-Bin Wan, Cheng-Zhong Li, Department of Infectious Diseases, Changhai Hospital, Shanghai 200433, China
Jun Ye, Department of Infectious Diseases, Putou District Central Hospital, Shanghai 200062, China
Xiong Cai, Department of Infectious Diseases, Changzheng Hospital, Shanghai 200003, China
Cheng-Wei Chen, Shanghai Liver Diseases Research Center, Nanjing Military Command, Shanghai 200233, China
Ji-Yao Wang, Department of Gastroenterology, Zhongshan Hospital, Shanghai 200032, China
Shan-Ming Wu, Shanghai Infectious Hospital, Shanghai 200085, China
Jin-Shui Zhu, Department of Gastroenterology, Shanghai NO.6 Hospital, Shanghai 200233, China
Xia-Qiu Zhou, Department of Infectious Diseases, Ruijin Hospital, Shanghai 200025, China
Author contributions: All authors contributed equally to the work.
Supported by the Key Project of Shanghai Medical Development Foundation, No.99ZDI001
Correspondence to: Lun-Gen Lu, MD, Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China. lulungen@online.sh.cn
Telephone: +86-21-33070834 Fax:+86-21-63364118
Received: April 2, 2003
Revised: June 12, 2003
Accepted: June 19, 2003
Published online: November 15, 2003
Abstract

AIM: To explore the grade and stage of pathology and the relationship between grading and staging of hepatic fibrosis and noninvasive diagnostic parameters.

METHODS: Inflammatory activity and fibrosis of consecutive liver biopsies from 200 patients with chronic liver disease were determined according to the Diagnostic Criteria of Chronic Hepatitis in China, 1995. A comparative analysis was made in these patients comparing serum markers, Doppler ultrasonography, CT and/or MR imaging with the findings of liver biopsy.

RESULTS: With increase of inflammatory activity, the degree of fibrosis also rose. There was a close correlation between liver fibrosis and inflammatory activity. AST, GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, N-terminal procollagen III (P III NP), collagen type IV (Col IV), tissue inhibitors of metalloproteinases-1 (TIMP-1), alpha-2-macroglobulin, natural killer cells (NK), some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the degree of inflammatory activity. GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, Col IV, TIMP-1, alpha-2- macroglobulin, transforming growth factor-beta 1 (TGFβ1), NK, some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the staging of fibrosis. By regression analysis, the parameters used in combination to differentiate the presence or absence of fibrosis were age, GGT, the parameter of blood flow of portal vein per minute, the maximum oblique diameter of right liver by B ultrasound, the wavy hepatic surface contour by CT and/or MR. The sensitivity, specificity and accuracy of the above parameters were 80.36%, 86.67%, and 81.10%, respectively.

CONCLUSION: There is close correlation between liver fibrosis and inflammatory activity. The grading and staging of liver fibrosis are related to serum markers, Doppler ultrasonography, CT and/or MR imaging. The combination of the above mentioned noninvasive parameters are quite sensitive and specific in the diagnosis of hepatic fibrosis.

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