Background: In our country, the high prevalence of chronic liver diseases is influenced by factors such as hepatotoxic viruses, excessive alcohol and drug consumption, and a high incidence of obesity among the population. Although the point at which liver fibrosis becomes irreversible remains unclear, some researchers have suggested, based on clinical studies, that fibrosis may still be reversible in the early stages of cirrhosis. Aim: Therefore, in this study, we aimed to evaluate the degree of liver fibrosis using key markers involved in the pathogenesis of hepatic scarring—MMP-1 (matrix metalloproteinase-1), MMP-2 (matrix metalloproteinase-2), and PIIINP (N-terminal propeptide of type III procollagen)—as well as non-invasive serum markers of hepatocyte injury (APRI and FIB-4), and to compare these findings with the results of liver biopsy. Materials and Methods: This analytical case-control study included 50 patients in the State Third Central Hospital. Peripheral blood samples were analyzed for platelet count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) using a fully automated analyzer, while serum direct markers were measured using ELISA. Non-invasive serum markers (APRI and FIB-4) were calculated using the MD+CALC online system. Liver tissue for histological examination was obtained via biopsy, and the degree of liver fibrosis was assessed according to the METAVIR scoring system. Differences in mean values of quantitative variables between two groups were analyzed using the Mann-Whitney U test was applied. The correlation between METAVIR stages and serum markers was evaluated using Spearman’s correlation. Results: Among the study participants, according to the METAVIR classification, 15 individuals (30%) had no or minimal fibrosis (F0–F1), 26 individuals (52%) had significant fibrosis without cirrhosis (F2–F3), and 9 individuals (18%) had cirrhosis (F4). As the stage of fibrosis increased, the mean levels of AST (r=0.326, p=0.021), ALT (r=0.392, p=0.005), MMP-2 (r=0.393, p=0.005), PIIINP (r=0.472, p=0.001), as well as APRI (r=0.503, p<0.001) and FIB-4 (r=0.482, p<0.001) showed an increasing trend. In contrast, mean platelet count (r=–0.507, p<0.001) and MMP-1 (r=–0.383, p=0.006) decreased with advancing fibrosis stages. Using AUC-ROC analysis to assess the diagnostic performance of both direct and indirect serum markers, the ability to detect significant fibrosis and cirrhosis was estimated as follows: APRI 80%, FIB-4 75%, MMP-1 67.1%, MMP-2 72.2%, and PIIINP 72.3%. Conclusion In our study, the diagnostic performance of both direct and indirect serum markers for predicting liver fibrosis exceeded 65%. Mean levels of AST, ALT, MMP-2, PIIINP, APRI, and FIB-4 increased with advancing fibrosis stages, whereas mean platelet counts and MMP-1 levels decreased.

BACKGROUND. HCV-infected and obesity related liver diseases are leading to increases in the prevalence of advanced liver disease. So, studying liver disease, especially liver fibrosis is crucial issue of today. In Mongolia digestive system disease is second causation of non-communicable disease. Therefrom in last years hepatocellular carcinoma is most common malignancy, first of all cancers in Mongolia. In response to acute or chronic liver injury, hepatic fibrosis is the accumulation of extracellular matrix and ultimately leads to cirrhosis. Cirrhosis is the end-stage of fibrosis, resulting in nodule formation that may lead to altered hepatic function and blood flow. Defining the phase of liver fibrosis is crucial for therapeutic choice prognosis, important role in monitoring treatment. At the present time, use of direct and undirect biomarkers methods could be recommended for liver fibrosis stage. The aim of this study is to determine liver fibrosis stage and to compare undirect biomarkers in chronic viral hepatitis, cirrhosis. METHODS: 630 cases by chronic viral hepatitis and cirrhosis at third central hospital in Mongolia from retrospectively reviewed and analysed. The clinical data including AST, ALT, platelet count and INR were recorded. APRI, FIB-4, AAR and FibroQ were calculated. RESULT: From all, males 42.06% and females 57.94%, with mean age of 55.35±24.0, in 130 cases with chronic viral hepatitis and 500 cases with cirrhosis. In cases of cirrhosis, mean value of platelet count, ALT, AST, INR was 120.54±73.53, 104.55±500.22, 111.68±279.97, 2.19±10.45, respectively. And in cases of chronic viral hepatitis platelet count mean value was 211.18±6.42. APRI was detected <0.5 cutoff value (F0-F1) 11.7% non-fibrosis, 0.5-1.5 score (F2-F3) 27.5% fibrosis, >1.5 cutoff value (F4) 60.8% cirrhosis. FIB-4 was determined <1.45 cutoff value (F0-F1) 14.8% non-fibrosis, 1.45-3.25 score (F2-F3) 15.7% fibrosis, >3.25 cutoff value (F4) 69.5%, AAR was showed <0.4 cutoff value (F0-F1) 2.3% non-fibrosis, 0.4-1 score (F2-F3) 30.2% fibrosis, >1 cutoff value (F4) 67.5%. And FibroQ was detected <0.6 cutoff value (F0- F1) 0.5% non-fibrosis, 0.6-2.6 score (F2-F3) 6% fibrosis, cutoff value 2.6< (F4) 93.5 cirrhosis. In study liver fibrosis staging by APRI, AAR, FIB-4 and FibroQ score system, AAR was determined fibrosis in 190 cases. CONCLUSION: Recorded data ALT, AST, INR in cases of cirrhosis were detected 104.55±500.22, 111.68±279.97, 2.19±10.45, respectively. And in cases of chronic hepatitis platelet count mean value was 211.18±6.42. APRI, AAR, FIB-4, FibroQ was determined fibrosis 27.5%,30.16%,15.71% and 6.03%, respectively.