Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya31918Editorial articleПередовая статьяResearch ArticleA new non-invasive method for assessing steatosis in chronic liver diseasesНовый неинвазивный метод оценки стеатоза при хронических заболеваниях печениBakulinI GБакулинИ ГSandlerYu GСандлерЮ ГKeyanV AКейянВ АRotinD LРотинД Л«Московский клинический научно-практический центр» Департамента здравоохранения Москвы15022016882VOL 88, NO2 ()ТОМ 88, №2 (2016)495710042020Copyright ©; 2016, Consilium MedicumCopyright ©; 2016, ООО "Консилиум Медикум"2016Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/31918

Aim. To assess the diagnostic accuracy of the controlled attenuation parameter (CAP) to determine the grade of hepatic steatosis (HS) in patients with chronic liver diseases (CLD) of different etiologies and to compare the obtained results with morphological findings. Subjects and methods. A total of 45 patients (18 men and 27 women) aged 25 to 73 years with CLD were examined. All the patients underwent liver puncture biopsy for assessing the HS index and fibrosis stage, as well as determination of hepatic elasticity (F, kPa) for estimating the stage of fibrosis and the grade of HS by CAP (S, dB/m) using a FibroScan device. When assessing HS, the CAP values of <229, 230—249, 250—276, and more than 277 dB/m correspond to HS grade 0 (S0), S1, S2, and S3, respectively. This is a pilot study in Russia. Results. CAP is a rather high effective method in determining the absence of steatosis (S0) (the area under the receiver operating characteristics curve (AUROC) was 0.78) and severe steatosis (S3) (AUROC 0.90). AUROC was 0.64 and 0.59 for HS S1 and S2, which is regarded as satisfactory and poor results, respectively. Only 3 out of the 45 patients had HS, as evidenced by morphological examination; and the results of CAP showed another result; all the other cases had a HS grade corresponding to S1. In the entire cohort of the examinees, the sensitivity, specificity, and accuracy of CAP was 86, 69.5, and 78%, respectively; AUROC was 0.77 (95% CI, 0.6587—0.9006; p=0.40). Conclusion. CAP is a promising method for the rapid and non-invasive diagnosis of HS in patients with CLD. At the same time, our findings show that it is necessary to clarify the quantitative indicators of the compliance of CAP and morphological evaluation of HS.

Резюме Цель исследования. Оценка диагностической точности метода контролируемого параметра затухания ультразвука (КПЗУ) в определении степени стеатоза печени (СП) у пациентов с хроническими заболеваниями печени (ХЗП) различной этиологии и сравнение полученных результатов с данными морфологического исследования. Материалы и методы. Обследовали 45 пациентов (18 мужчин и 27 женщин в возрасте от 25 до 73 лет) с ХЗП. Всем больным проведены пункционная биопсия печени с оценкой индекса СП и стадии фиброза, а также определение эластичности печени (F, кПа) для оценки стадии фиброза и степени СП методом КПЗУ (S, дБ/м) при помощи аппарата FibroScan. При оценке СП значения КПЗУ <229 дБ/м соответствуют степени СП 0 — S0, 230—249 дБ/м — S1, 250—276 дБ/м — S2, более 277 дБ/м — S3. Исследование является пилотным в России. Результаты. Метод КПЗУ достаточно высоко определяет отсутствие СП — S0 (площадь под характеристической кривой — AUROC составила 0,78), а также выраженный стеатоз — S3 (AUROC 0,90). Для определения степеней СП S1 и S2 — AUROC 0,64 и 0,59, что расценивается соответственно как удовлетворительный и неудовлетворительный результат. Среди 45 человек всего у 3 данные морфологического метода свидетельствовали о наличии СП, а результаты КПЗУ отражали другой результат; во всех этих случаях — степень СП, соответствующая S1. Чувствительность КПЗУ в общей когорте исследования составила 86%, специфичность — 69,5%, точность — 78%, AUROC 0,77 (при 95% доверительном интервале от 0,6587 до 0,9006; р=0,40). Заключение. КПЗУ является перспективным методом для быстрой и неинвазивной диагностики СП у пациентов с ХЗП. Вместе с тем полученные нами результаты показали необходимость уточнения количественных параметров соответствия КПЗУ и морфологической оценки СП.

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