Elevated serum type IV collagen: a sensitive indicator of the presence of cirrhosis in haemochromatosis
Section snippets
Patients
Forty-two patients with haemochromatosis were studied in this study. The diagnosis of haemochromatosis was made by established clinical and biochemical criteria 1., 2. and confirmed by histological and biochemical assessment of liver biopsy specimens. The hepatic iron index (HII) was >2.0 in 40 of the 42 patients. One patient did not have a hepatic iron concentration (HIC) measurement but had grade 4 iron deposition on Perls' stain and was HLA identical to a sibling with established
Histology
Histological evaluation of liver biopsies showed eight patients had no fibrosis (grade 0), whereas eight, 16 and five patients had grade 1, 2 and 3 fibrosis, respectively. Five patients had cirrhosis (grade 4). Fourteen patients had mild (grade 1) acinar or portal inflammation.
Serum laminin
There was no significant difference between the mean serum laminin concentration of control subjects and patients with haemochromatosis (251±112 ng/ml vs 237±143 ng/ml). Within the group of haemochromatosis patients there
Discussion
These results demonstrate that an elevated serum type IV collagen concentration is a sensitive indicator of severe fibrosis or cirrhosis in patients with hereditary haemochromatosis and can be used in clinical decision making as to whether liver biopsy is indicated in patients identified as having homozygous haemochromatosis by genetic testing. The results of this study also demonstrate that serum fibrosis markers shown to be useful in other chronic liver diseases do not necessarily extrapolate
Acknowledgements
This study was funded by a grant from the National Health and Medical Research Council of Australia (GAR, LWP, DHGC). Dr. George was supported by a Bancroft Scholarship from The Queensland Institute of Medical Research and a Wellcome Travel Scholarship.
Portions of this work have been presented at the annual meeting of the European Association for the Study of Liver and have been published in abstract form (J Hepatol 1998; 28(Suppl): A142).
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