Noninvasive diagnosis of liver fibrosis in patients with nonalcoholic fatty liver disease

Abstract

Background. Nonalcoholic fatty liver disease (NAFLD) includes a spectrum of diseases associated with insulin resistance and metabolic disorders, such as obesity, type 2 diabetes mellitus and dyslipidemia. NAFLD includes simple steatosis, which has a benign course, nonalcoholic steatohepatitis, which can progress to cirrhosis and hepatocellular carcinoma. Liver biopsy is the gold standard for assessing the degree of steatosis, liver inflammation and fibrosis; however, a growing interest in recent years is caused by noninvasive methods, including evaluation of various indices based on serum markers. The purpose of the study was the evaluation of serum markers and noninvasive laboratory indices in identifying morphological changes in the liver of patients with nonalcoholic fatty liver disease. Materials and methods. The study included patients with NAFLD, who underwent examination and treatment in the SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. The study involved 60 patients with NAFLD, including 26 (43 %) men and 34 (57 %) women, average age of the patients was (37.1 ± 12.4) and (44.30 ± 7.25) years, respectively. All patients had completed the study of serum hyaluronic acid, a2-macroglobulin, apolipoprotein A1, fibronectin, haptoglobin, calculation of noninvasive indices of liver fibrosis: AAR, APRI, FIB-4, percutaneous core needle liver biopsy with subsequent morphological study of tissues. Results. In patients with NAFLD, we have established a high diagnostic accuracy of serum markers of fibrosis, both in differentiation of various stages of fibrosis and the exclusion of fibrosis presence. Conclusions. Determination of serum markers is important in the choice of treatment, and the correspondence of non-invasive markers to the gold standard — morphological study allows to avoid liver biopsy as a method with potential complications due to its invasiveness.

Keywords

• nonalcoholic fatty liver disease
• liver fibrosis
• liver biopsy
• noninvasive diagnostic methods