nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-177-5-61-66nogr-1330Research ArticleЭКСПЕРИМЕНТАЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯEXPERIMENTAL GASTROENTEROLOGYНеинвазивные методы диагностики стеатоза при неалкогольной жировой болезни печениNoninvasive methods of diagnosis of steatosis in non-alcoholic fatty liver diseasehttps://orcid.org/0000-0001-6586-0843ЖирковИ. И.ZhirkovI. I.

Жирков Игорь Иванович, кафедра госпитальной терапии, к. м. н., докторант

Санкт-Петербург

Igor I. Zhirkov, Department of Hospital Therapy

igor1403@mail.ruhttps://orcid.org/0000-0002-6901-6436ГордиенкоА. В.GordienkoA. V.

Гордиенко Александр Волеславович, кафедра госпитальной терапии, д. м. н., профессор, заведующий кафедрой

Санкт-Петербург 

Alexander V. Gordienko, Department of Hospital Therapy, Professor, M.D.

Saint-Petersburg 

https://orcid.org/0000-0001-8669-5322ПавловичИ. М.PavlovichI. M.

Павлович Игорь Михайлович, кафедра госпитальной терапии, д. м. н., доцент, профессор кафедры

Санкт-Петербург 

Igor M. Pavlovich, Department of Hospital Therapy, Professor, M.D

Saint-Petersburg 

ГолофеевскийВ. Ю.GolofeevskyV. Yu.

Голофеевский Вячеслав Юрьевич, кафедра военно-полевой терапии, д. м. н., профессор, профессор кафедры

Санкт-Петербург 

Vyacheslav Yu. Golofeevsky, Department of Military Therapy, Professor, M.D.

Saint-Petersburg 

https://orcid.org/0000-0003-3619-7717МаковееваО. В.MakoveevaO. V.

Маковеева Ольга Владимировна, кафедра госпитальной терапии, к. м. н., доцент, доцент кафедры

Санкт-Петербург 

Olga V. Makoveeva, Department of Hospital Therapy, Senior Lecturer;

Saint-Petersburg 

ФГБВОУВО «Военно-медицинская академия им. С. М. Кирова МО РФ»РоссияFederal state budgetary military educational institution of higher education “S. M. Kirov Military medical Academy” of the Defense Ministry of the Russian FederationRussian Federation20202806202017456166Copyright © Жирков И.И., Гордиенко А.В., Павлович И.М., Голофеевский В.Ю., Маковеева О.В., 20202020Жирков И.И., Гордиенко А.В., Павлович И.М., Голофеевский В.Ю., Маковеева О.В.Zhirkov I.I., Gordienko A.V., Pavlovich I.M., Golofeevsky V.Y., Makoveeva O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1330

Цель исследования: изучить диагностические возможности неинвазивных методов оценки стеатоза печени у пациентов с НАЖБП. Материалы и методы: в исследование включено 240 пациентов мужского пола в возрасте от 21 до 54 лет (средний возраст 41,1 ± 8,1 лет), из них 172 с неалкогольной жировой болезнью печени, 68 без данной патологии. Всем выполняли измерение антропометрических показателей, биохимическое исследование сыворотки крови, ультразвуковое исследование гепатобилиарной зоны, расчет диагностических индексов стеатоза (FLI и HSI), неинвазивное определение степени стеатоза на аппарате FibroScan c функцией CAP. Результаты: значения CAP аппарата FibroScan, а также показатели предиктивных индексов стеатоза достоверно (p<0,05) отличались в исследуемых группах; качество диагностических моделей, оцениваемое по показателю AUROC, у индексов стеатоза FLI и HIS признано как отличное, у значения CAP аппарата FibroScan как очень хорошее.

The aim of the research: to study the diagnostic capabilities of non-invasive methods for the diagnosis of hepatic steatosis in patients with NAFLD. Materials and methods: the study included 240 male patients aged 21 to 54 years (mean age 41,1 ± 8,1 years), 172 of them with non-alcoholic fatty liver disease, 68 without this pathology. All performed measurement of anthropometric parameters, biochemical study of blood serum, ultrasound examination of the hepatobiliary zone, calculation of diagnostic indices of steatosis (FLI and HSI), non-invasive determination of the degree of steatosis on the device FibroScan with function CAP. Results: the CAP values of the FibroScan apparatus, as well as indicators of predictive steatosis indices signifi cantly (p<0,05) diff ered in the study groups; the quality of diagnostic models, estimated by the AUROC index, in the steatosis indices FLI and HIS was recognized as excellent, in the CAP values of the FibroScan apparatus as very good.

неалкогольная жировая болезнь печенистеатоз печенинеинвазивная диагностикаCAPFLIHISAUROCnon-alcoholic fatty liver diseaseliver steatosisnon-invasive diagnosisCAPFLIHISAUROCReferencesYounossi Z. M., Koenig A. B., Abdelatif D. et al. Global epidemiology of nonalcoholic fatty liver disease – meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 2016, Vol. 63, pp. 73–84.Younossi Z. M., Koenig A. B., Abdelatif D. et al. Global epidemiology of nonalcoholic fatty liver disease – meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 2016, Vol. 63, pp. 73–84.Лазебник Л. Б., Радченко В. Г., Голованова Е. В. и соавт. Неалкогольная жировая болезнь печени: клиника, диагностика, лечение (рекомендации для терапевтов, 2-я версия) // Экспер. и клин. гастроэнтерол. – 2017. – № 2 (138). – С. 22–37. Lazebnik L. B., Radchenko V. G., Golovanova E. V., et al. Nonalcoholic fatty liver disease: clinic, diagnostics, treatment (Recommendations for therapists, 2nd edition). Experimental and Clinical Gastroenterology. 2017;(2):22–37. (In Russ.)Лазебник Л. Б., Радченко В. Г., Голованова Е. В. и соавт. Неалкогольная жировая болезнь печени: клиника, диагностика, лечение (рекомендации для терапевтов, 2-я версия) // Экспер. и клин. гастроэнтерол. – 2017. – № 2 (138). – С. 22–37. Lazebnik L. B., Radchenko V. G., Golovanova E. V., et al. Nonalcoholic fatty liver disease: clinic, diagnostics, treatment (Recommendations for therapists, 2nd edition). Experimental and Clinical Gastroenterology. 2017;(2):22–37. (In Russ.)Ивашкин В. Т. Драпкина О. М., Маев И. В. и соавт. Распространенность неалкогольной жировой болезни печени у пациентов амбулаторно-поликлинической практики в Российской Федерации: результаты исследования DIREG 2 // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2015. – № 6. – С. 31–41. Ivashkin V. T., Drapkina O. M., Mayev I. V. et al. Prevalence of non-alcoholic fatty liver disease in out-patients of the Russian Federation: DIREG 2 study results. Russian Journal of Gastroenterology. Hepatology, Coloproctology, 2015, Vol. 25, no. 6, pp. 31–41. (In Russian)Ивашкин В. Т. Драпкина О. М., Маев И. В. и соавт. Распространенность неалкогольной жировой болезни печени у пациентов амбулаторно-поликлинической практики в Российской Федерации: результаты исследования DIREG 2 // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2015. – № 6. – С. 31–41. Ivashkin V. T., Drapkina O. M., Mayev I. V. et al. Prevalence of non-alcoholic fatty liver disease in out-patients of the Russian Federation: DIREG 2 study results. Russian Journal of Gastroenterology. Hepatology, Coloproctology, 2015, Vol. 25, no. 6, pp. 31–41. (In Russian)Жирков И. И., Гордиенко А. В., Гуляев Н. И. и соавт. Хронические диффузные заболевания печени невирусной этиологии у военнослужащих // Вестн. Росс. воен.-мед. акад. – 2019. – № 4 (68). – С. 72–76. Zhirkov I. I., Gordienko A. V., Gulyaev N. I. et al. Chronic diffuse liver disease of non-viral etiology in the military. Vestnik rossiyskoy voyenno-meditsinskoy akademii, 2019, Vol. 68, no. 4, pp. 72–76. (In Russian)Жирков И. И., Гордиенко А. В., Гуляев Н. И. и соавт. Хронические диффузные заболевания печени невирусной этиологии у военнослужащих // Вестн. Росс. воен.-мед. акад. – 2019. – № 4 (68). – С. 72–76. Zhirkov I. I., Gordienko A. V., Gulyaev N. I. et al. Chronic diffuse liver disease of non-viral etiology in the military. Vestnik rossiyskoy voyenno-meditsinskoy akademii, 2019, Vol. 68, no. 4, pp. 72–76. (In Russian)EASL-EASD-EASO Clinical Practice Guideline for the management of non-alcoholic liver disease. European Association for the Study of the Liver (EASL) and European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO). Diabetologia, 2016, Vol. 59, pp. 1121–1140.EASL-EASD-EASO Clinical Practice Guideline for the management of non-alcoholic liver disease. European Association for the Study of the Liver (EASL) and European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO). Diabetologia, 2016, Vol. 59, pp. 1121–1140.Bedossa, P. FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology, 2014, Vol. 60, pp. 565–575.Bedossa, P. FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology, 2014, Vol. 60, pp. 565–575.Long Wang, Jinghui Guo, Jianping Lu. Risk factor compositions of nonalcoholic fatty liver disease change with body mass index in males and females. Oncotarget. – 2016, Vol. 7, no. 24, pp. 35632–35642.Long Wang, Jinghui Guo, Jianping Lu. Risk factor compositions of nonalcoholic fatty liver disease change with body mass index in males and females. Oncotarget. – 2016, Vol. 7, no. 24, pp. 35632–35642.Sasso M., Tengher-Barna I., Ziol M. et al. Controlled attenuation parameter (CAP): a novel VCTE® guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med. Biol, 2010, Vol. 36, no. 11, pp. 1825–1835.Sasso M., Tengher-Barna I., Ziol M. et al. Controlled attenuation parameter (CAP): a novel VCTE® guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med. Biol, 2010, Vol. 36, no. 11, pp. 1825–1835.Chon Y. E., Jung K. S., Kim S. U. et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int, 2014, Vol. 34, no. 1, pp. 102–109.Chon Y. E., Jung K. S., Kim S. U. et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int, 2014, Vol. 34, no. 1, pp. 102–109.Masaki K., Takaki S., Hyogo H. et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver diseases. Hepatol. Res. 2013, Vol. 43, no. 11, pp. 1182–1189.Masaki K., Takaki S., Hyogo H. et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver diseases. Hepatol. Res. 2013, Vol. 43, no. 11, pp. 1182–1189.Yoneda M. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver disease. Hepatol. Res, 2013, Vol. 43, no. 11, pp. 1125–1126.Yoneda M. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver disease. Hepatol. Res, 2013, Vol. 43, no. 11, pp. 1125–1126.de Lédinghen V, Vergniol J., Foucher J. et al. Noninvasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int, 2012, Vol. 32, no. 6, pp. 911–918.de Lédinghen V, Vergniol J., Foucher J. et al. Noninvasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int, 2012, Vol. 32, no. 6, pp. 911–918.Bedogni G., Bellentani S., Miglioli L. et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 2006, no. 6, 33 p.Bedogni G., Bellentani S., Miglioli L. et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 2006, no. 6, 33 p.Kotronen A., Peltonen M., Hakkarainen A. et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology, 2009, Vol. 137, no. 3, pp. 865–872.Kotronen A., Peltonen M., Hakkarainen A. et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology, 2009, Vol. 137, no. 3, pp. 865–872.Lee J. H., Kim D., Kim H. J. et al. Hepatic steatosis index: a simple screening tool refl ecting nonalcoholic fatty liver disease. Dig. Liver Dis, 2010, Vol. 42, pp. 503–508.Lee J. H., Kim D., Kim H. J. et al. Hepatic steatosis index: a simple screening tool refl ecting nonalcoholic fatty liver disease. Dig. Liver Dis, 2010, Vol. 42, pp. 503–508.Poynard T., Ratziu V., Naveau S. et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp. Hepatol, 2005, Vol. 4, pp. 1–10.Poynard T., Ratziu V., Naveau S. et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp. Hepatol, 2005, Vol. 4, pp. 1–10.

The authors declare that there are no conflicts of interest present.