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Serum hyaluronan and collagen IV as non-invasive markers of liver fibrosis in patients from an endemic area for schistosomiasis mansoni: a field-based study in Brazil
Marinho, Carolina Coimbra; Bretas, Thales; Voieta, Izabela; de Queiroz, Leonardo Campos; Ruiz-Guevara, Raiza; Teixeira, Antônio Lúcio; Antunes, Carlos Maurício; Prata, Aluízio & Lambertucci, José Roberto
Abstract
Non-invasive markers of fibrosis have been used to diagnose liver fibrosis in a variety of diseases. Hyaluronic
acid (HA) and collagen IV (C-IV) levels were measured in the sera of patients from an endemic area for
schistosomiasis in Brazil to diagnose and to rank the intensity of liver fibrosis. Seventy-nine adult patients with
schistosomiasis, in the age range of 21-82 years (49 ± 13.4) were submitted to clinical and ultrasonographic examinations.
Ultrasound was employed to diagnose and categorise liver fibrosis according to World Health Organization
patterns. Serum HA and C-IV levels were measured using commercial ELISA kits. Ultrasound revealed six patients with
intense liver fibrosis, 21 with moderate, 23 with light and 29 without. Serum HA was able to separate individuals
with fibrosis from those without (p < 0.001) and light from intense fibrosis (p = 0.029), but C-IV was not (p = 0.692).
The HA diagnostic accuracy for fibrosis was 0.89. The 115.4 ng/mL cut-off level diagnosed patients with fibrosis
(sensitivity 0.98, specificity 0.64). HA correlated positively with portal hypertension. Periportal fibrosis (subjective
evaluation), age and collateral circulation predicted HA increase. In conclusion, we propose that serum HA can be
used to identify patients with liver fibrosis in an endemic area for schistosomiasis mansoni in Brazil.
Keywords
schistosomiasis - ultrasound - liver fibrosis - hepatosplenic schistosomiasis - fibrosis markers
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