[Noninvasive assessment of liver fibrosis in patients with chronic hepatitis virus C].

Development of liver fibrosis, which leads to cirrhosis, is the principal complication of all chronic liver diseases, regardless of their cause. Knowledge of the existence and severity of fibrosis is important from diagnostic and prognostic viewpoints. Its assessment plays an essential role in the treatment decision and makes it possible to assess the risk of progression to cirrhosis and the onset of its complications. Histologic examination of the liver remains the reference examination for assessing the extent of fibrosis during chronic liver disease. Nonetheless, the number of patients needing assessment, the risks of the punch-biopsy and the cost of this invasive examination have led many to propose other tools to assess fibrosis. Some standard indicators (transaminases, platelets, prothrombin time) have long been recognized as indirect markers of extensive fibrosis. More recently, progress in our knowledge of the mechanisms of liver fibrogenesis have made it possible to identify different peripheral blood components that may be of clinical interest. Thus serum assays of elements of the extracellular matrix, their decay products, or enzymes involved in their metabolism have been proposed as noninvasive indicators. Among these, hyaluronic acid appears the most interesting. For several years, scores have been calculated with algorithms that combine several indicators determined simultaneously to assess fibrosis in patients with hepatitis C and sometimes other chronic liver diseases. The Fibrotest is the best validated and most widely used of these. Finally, Fibroscan is a device for the diagnosis and quantification of hepatic fibrosis, based on the technique of transient elastography. The relative roles of these noninvasive markers and the value of their combinations must still be determined.