Noninvasive diagnostic methods for liver fibrosis in children with chronic hepatitis B infection

Introduction: Our study is designed to compare noninvasive blood samplingmethods versus liver biopsy in the diagnostic value of liver fibrosis level assesment inchronic hepatitis B infected children.Patient and Methods: Thirty-five children aged 2-18 years diagnosed with chronicHepatitis B infection (Group 1) in the Pediatric Gastroenterology Department of theMedical Faculty of Celal Bayar University were enrolled in the study. The control group(Group 2) consisted of 15 age-matched healthy children.Serum levels of patients with noninvasive FibroTest fibrosis levels and noninvasiveAktitest activity levels were compared with fibrosis and activity levels obtained byhistopathological evaluation. YKL-40 and MMP-9 levels were measured with ELISAmethods. The collected data were analyzed using the SPSS for Windows program (Version 10.0)Result: Patients group (Group 1) and control group (Group 2) has the samedemographic (age, sex) features. Actitest and Fibrotest mediated activity-fibrosis levelswere not statistically different from the histopathologically mediated activity-fibrosislevels; respectively p=1.00 and p=0.432. Actitest sensitivity 31%, specifity 68%, positivepredictive value 31% and negative predictive value was 32% in predicting the fibrosoislevelin the patient group. Fibrotest sensitivity 36%, specifity 81%, positive predictive value56% and negative predictive value was 36% in predicting the necroinflamatuary activity inthe patient group. MMP-9 and YKL-40 levels were higher in patients group (Group 1)compared to control group (Group 2) respectively p=0.01 and p= 0.02. AST, ALT, GGT,total bilirubine and activated partial tromboplastin time was statistically significantlyhigher, but total protein level was lower in the patient group.Conclusion: Liver biopsy is the gold standart diagnostic test for diagnosing andgrading liver fibrosis. Today the most advisable approach for liver fibrosis is liver biopsycombined with noninvasive blood tests, serological tests, imaging procedures and patientsclinical features.Key Words: Chronic hepatitis B infection, liver biopsy, Fibrotest, Actitest.