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LIV EVER

A simple blood test that can help save lives.

HEPATIC FIBROSIS [ HA LN PIIIP N -P C IV CG ]

When liver get invasion by various pathogenic factor agent, it will cause liver damage and inflammatory response. At the same time, liver's immune system get activated and try to repair the tissue. Hepatic fibrosis means when the tissue repair process is excessive and out of control, a pathological process of liver structure and function lead the liver to abnormal status, which is caused by excessive proliferation and abnormal sediment of extracellular matrix. The mild symptom is called hepatic fibrosis; the serious symptom is called cirrhosis, which is caused by liver lobular structure reconstruction, false liver lobules and nodules.

The pathological process of hepatic fibrosis & outcome

The pathological process of hepatic fibrosis & outcome

  • Imaging diagnosis: ultrasound is most common method to evaluate heptatic fibrosis in Imaging Diagnosis, but the Imaging diagnosis still have some limitation as it cann't assess the heptic fibrosis at early stage.
  • Histopathological examination : "Gold standard", Liver biopsy is a traumatic inspection, many patients do not willing to accept the inspection as piercing pain and other complications. The procedure is painful ('-30% of cases), hazardous (causes bleeding in -1 in 1,000.
  • Serodiagnosis : convenient sampling, low price, no wound more practical, it is the most widely used method to diagnose the hepatic fibrosis.Standardized assays (HA, PHINP, Collagen IV, Laminin, Cholyglycine) on automated platform. Found to be accurate to differentiate mild, moderate and severe fibrosis at least as good as biopsy at predicting liver disease -related outcomes.

Clinical application of hepatic fibrosis assay.

HA (hyaluronic acid) : a matrix component, can be more accurate and sensitive to reflect the status of fibrosis and damaged condition of liver cells. Some reports show the HA level is even better that Liver biopsy as it is sensitive indicator for hepatic fibrosis and cirrhosis.

HA level elevates a little in the acute and chronic persistent hepatitis patients' serum, significantly in chronic active hepatitis patient serum, extremely in liver cirrhosis patients' serum.

LN (laminim protein): as the special non -collagen structure protein in the basement membrane, LN is positively correlated with activity of hepatic fibrosis and high pressure of portal vien, in addition, when the LN level elevate, the esophageal varices in Cirrhosis patient show more visible.

  • Reflects status of hepatic fibrosis: normal liver interstitial contain few LN when the hepatic fibrosis and cirrhosis happen. Muscle fibroblasts increase, a large number of interstitial substance, such as collagen, LN, are synthesized and secreted, forming a complete beasement membrane (hepatic sinusoidal capillaration).
  • To diagnose whether there is portal hypertension in patient with alcohol liver.

PIIIP N -P (type Ill collagen N terminal peptide): reflect intrahepatic synthesis of (type II collagen, serum concentration and hepatic fibrosis level is consistent.

  • ) PIIIP N -P content is closely related with activity degree of hepatic 1) PIIIP N -P content is closely related with activity degree of hepatic also cause the elevation of PIIP N -P;
  • Regarding the CAH patient, constant elevation of PIIIP N -P imply the disease may worsen and develop to hepatocirrhosis. If PIIP N -P level down to normal, it imply remission of the illness. PIIP N -P is valuable not only in the early diagnosis of hepatic fibrosis, but also in the prognosis evaluation of chronic liver disease.
  • PIIP N -P content is closely related with the degree of hepatic fibrosis, reflecting synthesis status of hepatic fibrosis and activity of inflammation. The serum level elevate significantly in the early stage, but regarding liver cirrhosis patient, some hepatocirrhosis patient inlate stage and hepatatrophia patient, the PIIP N -P level may not elevate.

C IV (type IV collagen) : as the main component of basement membrane, the level can reflect the turnover rate of basement collagen Elevated C IV concentration, which can reflect liver fiber process sensitively, is one of the main marker of Hepatic fibrosis in early stage. To reflect the degree of hepatic fibrosis. With course of disease developing : CPH, CAH, cirrhosis, liver cancer, C IV concentration in serum increase gradually;

C IV level also elevate in severe hepatitis and alcoholic hepatitis. It's a important indicator for medical treatment and prognosis observation. C IV level in serum is consistent with liver's histological change completely.

CG (Cholyglycine) : CG is synthesized in the liver cells, discharging into cholecyst for storage through bile duct. Then it goes into the small intestine along with bile when gallbladder contraction after eating, participating in fat digestion and absorption. 95% of the bileacid, which is repuptaken to the blood by the small intestinal mucosa, will be transported to the liver via the portal vein and abosrted by liver cells. When the liver cell damage, the bile sit up to elevate CG content to serum.

  • Compared with normal group, the group with acute hepatitis, chronic active hepatitis, cirrhosis and primary liver cancer show obviously higher level.
  • The positive percentage from high to low: acute hepatitis, chronic active hepatitis, primary carcinoma of the liver (PHC), Liver cirrhosis;
  • Evaluate the therapeutic efficacy of hepatitis's treatment Serum CG concentration will decrease with the condition improved.
  • Serum CG test is considered to be the most sensitive indicator to diagnose the intrahepaticcholestasis of pregnancy (ICP).

Normal reference range of hepatic fibrosis serum markers

Item NormalUnit
HA< 100ng/ml
IN< 50ng/ml
P III N-P< 30 ng/ml
CIV< 30ng/ml
CG< 2.7ii.g/m1



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