Non-invasive diagnosis of hepatic fibrosis

Abstract

Introduction. Hepatic fibrosis is a worldwide health issue, whose prognosis; management and potential treatment depend on establishing the accurate diagnosis according to the progression of the disease. Modern medicine studies efficient, safe and non-invasive methods for the assessment of hepatic fibrosis, such as serum biomarkers and imaging techniques: FibroScan elastometry, MRI, ARFI.Aim of the study. Identification and study of the non-invasive methods for the diagnosis of hepatic fibrosis Materials and methods. A bibliographic study of scientific literature from 2009-2020 based on Biomed Central, Bio Predictive, ACS Publications data bases was done, with the following search words – hepatic fibrosis, non-invasive diagnosis, fibrotest, biomarker of fibrosis. Results. Serum biomarkers, used for the assessment of hepatic fibrosis, are classified in: direct biomarkers – Procollagen type I carboxy-terminal peptide (PICP), Procollagen type III aminoterminal peptide (PIIINP), matrix metalloproteinases (MMPs), tissue inhibitors of matrix metalloproteinases (TIMPs), hyaluronic acid (HA), transforming growth factor β1 (TGFβ1), laminin, connective tissue growth factor (CTGF); and indirect biomarkers – AST/ALT ratio, coagulation factors, platelet count, γ2-macroglobulin, γ2-globulin, γ-globulin, apolipoprotein A1, GGT, total bilirubin. These serum biomarkers are combined in non-invasive scores such as APRI, FibroTest, FIB-4. Transient Ultrasound Elastography or FibroScan measures liver stiffness (elasticity) and allows determining the stage of hepatic fibrosis according to METAVIR score: F1, F2, F3, and F4. MRI can be used to measure hepatic stiffness, and at the same time other associated pathologies.Conclusions. Management and individualized treatment of hepatic fibrosis depend on establishing an accurate stage diagnosis. Non-invasive methods, serum biomarkers and imaging techniques allow to determine a correct diagnosis and at the same time to minimize the complications. FibroTest, FibroScan and APRI score are methods that showed the highest clinical efficiency. However, recent studies are focused on identifying the correlation between tissue modifications, the results of serum biomarkers and FibroTest, FibroScan and APRI score.