Serum hyaluronic acid as a marker of the severity of fibrosis in alcoholic liver disease

Aime: to evaluate clinical and laboratory liver syndromes and markers of fibrosis in individuals with different severity of liver damage in the form of steatosis, steatohepatitis, and cirrhosis against the background of harmful alcohol consumption.

Materials and methods. 181 patients with alcoholic liver disease (ALD) were examined, the control group consisted of 92 healthy people. The survey included patient questionnaires, assessment of clinical status, biochemical tests, general blood analysis, ultrasound of the abdominal cavity, ultrasound elastography. Determination of the concentration of hyaluronic acid (HA) in blood serum was carried out by the ELISA method using a set of reagents from the manufacturer “VSM Diagnostics” (USA) on the Stat Fax device (USA). Statistical processing of the results was performed using the “Statistika 10” package.

Results. In ALD, more pronounced clinical manifestations and changes in laboratory tests were found in individuals with a greater severity of liver damage, which is associated with a greater alcohol load. The maximum number of reliable correlations was found between functional liver tests in alcoholic cirrhosis of the liver (ALC) — 16 tests, with steatohepatitis-7, with steatosis only between AST and direct bilirubin. The median concentration of ha in all groups was significantly higher than the control: in patients with steatosis, it was 31.1 [21.5; 49], in steatohepatitis with hyperfermentaemia — 45.55 [31.5; 69.9] ng / ml, in patients with cirrhosis of the liver — 145.7 [116.8; 377.8], significant differences in ALC were found with both steatosis and steatohepatitis. In ALC, all fibrosis tests: AST/ALT, APRI and HA correlated with all the studied liver samples, with less pronounced liver lesions on the background of ALD, there were almost no correlations. The relationship of indirect fibrosis tests — the ratio of AST/ALT and the APRI index with the level of HA was also not revealed.

Conclusion. HA, as a non-invasive direct marker, is the most informative early test of liver fibrosis. It allows you to accurately and simply diagnose the presence of fibrosis in ALD at the stage of steatosis, steatohepatitis and cirrhosis. Traditional indirect markers of fibrosis AST/ALT ratio and APRI index are ineffective, with the exception of ALC.

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