Association Between Serum Type III Collagen N-Terminal Propeptide (PRO-C3) Levels and Liver Fibrosis Severity in Patients with Chronic Hepatitis B
Keywords:
Chronic hepatitis B, Pro-C3, liver fibrosis, collagen type III, biomarkers, elastographyAbstract
Background and aim: Accurate assessment of liver fibrosis is essential for risk stratification and management of chronic hepatitis B (CHB). Procollagen Type III N-Terminal Propeptide (PRO-C3), a direct biomarker of collagen formation, has emerged as a promising indicator of active hepatic fibrogenesis. This study investigated the association between serum PRO-C3 levels and liver fibrosis severity using non-invasive fibrosis markers.
Methods: This cross-sectional study included 86 adults with CHB consecutively recruited between July and December 2025. Serum PRO-C3 concentrations were measured using enzyme-linked immunosorbent assay. Liver fibrosis was assessed using the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI), Fibrosis-4 Index (FIB-4), and liver stiffness measurement (LSM). Correlations were analyzed using Spearman's rank correlation, and differences among fibrosis stages were evaluated using the Kruskal–Wallis test.
Results: Serum PRO-C3 was positively correlated with APRI (r = 0.595, p < 0.001), FIB-4 (r = 0.340, p = 0.001), and LSM (r = 0.640, p < 0.001). Patients with advanced fibrosis had significantly higher PRO-C3 concentrations than those with non-fibrosis or significant fibrosis according to APRI and FIB-4 (both p < 0.05). Although the overall comparison across LSM categories was not significant (p = 0.056), post hoc analysis showed higher PRO-C3 levels in advanced fibrosis.
Conclusions: Serum PRO-C3 was significantly associated with liver fibrosis severity in CHB and may serve as a complementary non-invasive biomarker of active hepatic fibrogenesis. Larger prospective studies are needed to validate its clinical utility.
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