Comparison of diagnostic informative value of the methods for the determination of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Rithis coefficient) of liver fibrosis markers in patients with chronic viral hepatitis C

Moroz L.V., Bondaruk I. Yu. Comparison of diagnostic informative value of the methods for the determination of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Rithis coefficient) of liver fibrosis markers in patients with chronic viral hepatitis C. Journal of Education, Health and Sport. 2019;9(5):676-688. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3383708 http://ojs.ukw.edu.pl/index.php/johs/article/view/7379 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 29.04.2019. Revised: 15.05.2019. Accepted: 27.05.2019. Comparison of diagnostic informative value of the methods for the determination of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Rithis coefficient) of liver fibrosis markers in patients with chronic viral hepatitis C L.V. Moroz, I. Yu. Bondaruk N. I. Pirogov National Medical University Vinnitsa, Ukraine Abstract The results of chronic viral hepatitis C patients examinations are described. A comparative characteristic of the diagnostic informative value of direct (hyaluronic acid) and indirect (alanine aminotransferase, aspartate aminotransferase, de Ritis coefficient) of liver fibrosis markers by the use of ROC - analysis is presented. The objective: to explore the possibility of non-invasive methods for diagnosing liver fibrosis in patients with chronic viral hepatitis C (CVH C). Materials and methods. 66 CVH C with the 1st genotype of the virus were examined. They were either at dispensary observation or ambulatory treatment at Municipal Clinical Hospital №1 (Vinnitsa, Ukraine) and in the clinical department of viral hepatitis at L. V. Gromashevsky Institute of Epidemiology and Infectious Diseases of NAMS (Ukraine). All patients underwent fibroelastography (FEG) on the METAVIR fibrosis score. In all CVH C patients and control group individuals content of hyaluronic acid (HA) in blood serum was determined. ELISA method and “Hyaluronic Acid” kit (Corgenix, Inc., USA) were used. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity was investigated with kinetic method (analyzer and test system Cobas 6000, Roche Diagnostics, Switzerland). Results: AUC for HA content in serum of CVH C patients was in the range 0.720-0.917 (p<0.01). Signs of the cytolytic syndrome were recorded in 86.4% of the patients under examination. AUC for determining the value of ALT in serum in СVH С patients with liver fibrosis F0-F2 and F4 was less than 0.5. Sensitivity and specificity of blood serum ALT determination in the patients under study by the degree of liver fibrosis F3 were respectively 97.71% and 96,42% (AUC = 0.906; p <0.001). The method of determining the value of AST in serum of patients with CVH with fibrosis degree F0-F2 also has a low informativity (AUC<0.5). However, in the group of patients with F3 liver fibrosis, the sensitivity of this method (determination of AST) was 83.51% and specificity was 82.12% (AUC = 0.809,
p = 0.0428). The sensitivity and specificity of determining the serum AST value in patients with F4 fibroblasts was 78.23% and 75.25%, respectively (AUC = 0.817 (p = 0.011), were found to be slightly lower). Conclusions. High diagnostic informative value of the determination of the content of HA in serum was established for assessing the degree of liver fibrosis in patients with CVH C (AUC = 0.720 – 0.17, p<0,01). High diagnostic informativity for the method of determining the value of ALT in CVH C patients is only established in patients with F3 hepatic fibrosis (AUC = 0.906 (p <0.001)). For the method of determining the value of AST in CVH C patients, statistically reliable diagnostic informative data was established for patients F3 hepatic fibrosis grade (AUC = 0.809, p = 0.042) and F4
(AUC = 0.817, p = 0.011). Diagnostically significant informative of the method under discussion for determining the value of dRk in CVH C patients has been established in F3 hepatic fibrosis: AUC = 0.928 (p = 0,033). Key words: chronic viral hepatitis C, fibrosis, hyaluronic acid, alanine aminotransferase, aspartate aminotransferase, de Richtis factor.