Gastroenterologìa (Jun 2023)
Application of non-invasive methods of assessment of steatosis and fibrosis in chronic diffuse liver diseases of various etiologies
Abstract
Background. The aim of the study is to analyze the parameters of liver steatosis and fibrosis based on shear wave elastography (SWE) and steatometry data in patients with chronic diffuse liver diseases, taking into account the etiological factor, and determine the diagnostic accuracy of SWE in the diagnosis of liver fibrosis. Materials and methods. Three hundred and sixty-four patients with chronic diffuse liver disease aged (48.00 ± 1.84) years were examined, 159 (43.7 %) were male, and 205 (56.3 %) female. The patients were divided into groups: 108 people with non-alcoholic fatty liver disease (NAFLD), 143 with chronic hepatitis C (HCV), 56 with alcoholic liver disease (ALD), and 57 with drug-induced toxic hepatitis. In all patients, SWE and steatometry were performed by Soneus P7 device (Kharkiv, Ukraine) with the liver stiffness and ultrasound attenuation coefficient measurement. Results. According to SWE data, 270 (74.2 %) patients with chronic liver disease had fibrotic changes in the liver. A significant increase in liver stiffness by 1.9 times (p < 0.05) according to Young’s modulus was found in HCV patients and by 1.4 times (p < 0.05) in ALD patients compared to the control group, by 1.7 (p < 0.05) and 1.3 times (p < 0.05), respectively, compared to the group of patients with NAFLD. According to steatometry data, an increase in ultrasound attenuation coefficient by 30.2 % (p < 0.05) in patients with NAFLD, by 27.5 % (p < 0.05) in those with ALD and by 22 % (p < 0.05) in people with toxic hepatitis was found compared to the control group. In patients with liver fibrosis, the median liver stiffness was 6.70 kPa (6.35, 7.56), while in those without liver fibrosis, this parameter was 1.2 times lower (p < 0.01). Histological evaluation of liver samples obtained through percutaneous biopsy in 75 patients with chronic liver disease demonstrated the absence of fibrosis in 14 (18.7 %) cases. According to the results of the ROC analysis, the cut-off value of the liver stiffness determined by SWE was 5.79 kPa, confirming the presence of liver fibrosis in patients with chronic liver disease regardless of etiology (AUC = 0.901, p < 0.001). Conclusions. The liver stiffness determined by SWE in HCV and ALD patients was higher than in NAFLD patients (p < 0.05), as well as the frequency of F3–4 stages of liver fibrosis (p < 0.05). The threshold value of the liver stiffness for liver fibrosis diagnosis in chronic liver disease regardless of etiology was 5.79 kPa (sensitivity 100.0 %, specificity 85.7 %), which allows the family doctor to form a risk group of patients who needed dynamic monitoring with a further investigation of the etiological factor of liver fibrosis.
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