SERUM HYALURONATE AND TYPE-III PROCOLLAGEN AMINOTERMINAL PROPEPTIDE CONCENTRATION IN CHRONIC LIVER-DISEASE - RELATIONSHIP TO CIRRHOSIS AND DISEASE-ACTIVITY

To analyse the relationship between the presence of liver cirrhosis and hepatic inflammation and the serum concentrations of the aminoterminal propeptide of procollagen type III (P-III-NP) and of hyaluronic acid (HA) in chronic liver disease, we measured P-III-NP and HA concentrations in paired serum samples from 133 patients with various chronic liver diseases, from 22 patients with acute hepatitis and from 50 healthy age-matched controls. In 24 (of the 133) patients with autoimmune chronic liver disease, follow-up determination was performed during therapeutic treatment with immunosuppressive drugs. Compared with controls P-III-NP concentrations (medians) were significantly elevated in 65% of patients with chronic active hepatitis (P = 0.00097) and in 79% of patients with active liver cirrhosis (P = 0.0126) but not in patients with chronic persistent hepatitis (P = 0.06). Serum concentrations (medians) of HA were increased (P = 0.0058) in 32% of patients with chronic active hepatitis and in 91% of patients with active cirrhosis (P < 6 x 10(-7). The difference of HA serum concentrations but not that of P-III-NP serum concentrations in patients with chronic active hepatitis and in patients with active cirrhosis was statistically significant. HA and P-III-NP serum concentrations were significantly elevated in 22 patients with acute hepatitis. Serum concentrations of P-III-NP in patients with autoimmune chronic liver disease significantly decreased during immunosuppressive therapy in patients with autoimmune chronic active hepatitis (P = 0.0001) and in patients with autoimmune active cirrhosis (P = 0.0039); HA serum concentration decreased to normal level in patients with autoimmune chronic active hepatitis (P = 0.0017); in contrast, when cirrhosis was present, serum HA levels decreased but remained elevated (P = 0.129). It is concluded that determination of HA serum concentrations will help to differentiate chronic active hepatitis from active cirrhosis. While elevated P-III-NP serum concentrations mainly correlate with inflammatory activity, elevated HA serum concentrations seem to be an expression of mainly the reduced functional (clearance function) capacity of the liver in chronic liver diseases. Therefore determination of HA serum concentration is of greater diagnostic value, especially when inflammatory activity is low.