medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-225medsovet-9173Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERДиагностическая точность предиктивных индексов оценки стеатоза и фиброза печени в сравнении с транзиентной эластографией у пациентов с неалкогольной жировой болезнью печениDiagnostic accuracy of predictive indices for assessing liver steatosis and fibrosis as compared to transient elastography in patients with non-alcoholic fatty liver diseasehttps://orcid.org/0000-0002-9390-8303БрехунецР. М.BrekhunetsR. M.

Брехунец Рената Маратовна, аспирант кафедры пропедевтики внутренних болезней и гастроэнтерологии

127006, Москва, ул. Долгоруковская, д. 4

Renata M. Brekhunets, Postgraduate Student of the Department of Propaedeutics of Internal Diseases and Gastroenterology

4, Dolgorukovskaya St., Moscow, 127473

renata.94@mail.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreevD. N.

Андреев Дмитрий Николаевич, к.м.н., доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии

127006, Москва, ул. Долгоруковская, д. 4

Dmitry N. Andreev, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology

4, Dolgorukovskaya St., Moscow, 127473

dna-mit@mail.ruhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

Маев Игорь Вениаминович, академик РАН, д.м.н., профессор, Заслуженный врач РФ, Заслуженный деятель науки РФ, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии

127006, Москва, ул. Долгоруковская, д. 4

Igor V. Maev, Acad. RAS, Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Honored Scientist of the Russian Federation, Head of the Department of Propaedeutics of Internal Diseases and Gastroenterology

4, Dolgorukovskaya St., Moscow, 127473

igormaev@rambler.ruhttps://orcid.org/0000-0001-9224-7382ДичеваД. Т.DichevaD. T.

Дичева Диана Тодоровна, к.м.н., доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии

127006, Москва, ул. Долгоруковская, д. 4

Diana T. Dicheva, Cand. Sci. (Med.), Associate Professor, Associate Professor of Department of Propaedeutics of Internal Diseases and Gastroenterology

4, Dolgorukovskaya St., Moscow, 127473

di.di4eva@yandex.ruhttps://orcid.org/0000-0002-7501-9473КулиеваА. К.KulievaA. K.

Кулиева Алла Киримовна, к.м.н., ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии

127006, Москва, ул. Долгоруковская, д. 4

Alla K. Kulieva, Cand. Sci. (Med.), Assistant Professor at the Department of Propaedeutics of Internal Diseases and Gastroenterology

4, Dolgorukovskaya St., Moscow, 127473

kak51@yandex.ruРоссийский университет медицины (РосУниМед)РоссияRussian University of Medicine (ROSUNIMED)Russian Federation20251806202508113119Copyright © Брехунец Р.М., Андреев Д.Н., Маев И.В., Дичева Д.Т., Кулиева А.К., 20252025Брехунец Р.М., Андреев Д.Н., Маев И.В., Дичева Д.Т., Кулиева А.К.Brekhunets R.M., Andreev D.N., Maev I.V., Dicheva D.T., Kulieva A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9173Введение

Введение. Неалкогольная жировая болезнь печени (НАЖБП) представляет глобальную проблему для общественного здравоохранения. Согласно данным исследований, известно, что смертность от всех причин значительно возрастает при фиброзе печени F ≥ 2, в связи с чем решающее значение в первичной диагностике фиброза и стеатоза печени играют предиктивные индексы (ПИ).

Цель

Цель. Оценить диагностическую точность ПИ стеатоза (FLI, ST) и фиброза печени (FIB-4, APRI, NFS) по сравнению с транзиентной эластографией (ТЭ) при идентификации фиброза и стеатоза печени у пациентов с НАЖБП.

Материалы и методы

Материалы и методы. В исследование включено 142 пациента с НАЖБП. Всем пациентам был выполнен расчет вышеуказанных ПИ, ТЭ с функцией CAP. Сравнение диагностической точности ПИ фиброза и стеатоза печени проводилось с ТЭ как референтным методом. Всем пациентам проводилась кистевая динамометрия для определения силы хвата рук (СХР).

Результаты

Результаты. Пороговое значение (ПЗ) для индекса FIB-4 > 1,94 для дифференцировки выраженного ФП и цирроза (F3-F4): показатель AUC = 0,643, чувствительность – 34,78%, специфичность – 90,62. Для индекса APRI ПЗ >0,44 для дифференцировки выраженного ФП и цирроза (F3-F4): показатель AUC = 0,615, чувствительность – 54,35%, специфичность – 67,71. Для индекса NFS ПЗ > 26,38 для дифференцировки выраженного фиброза и цирроза печени (F3-F4): показатель AUC = 0,681, чувствительность – 58,7%, специфичность – 79,1. Для индекса ST ПЗ > 0,054 для дифференцировки выраженного стеатоза печени (S2-S3): показатель AUC = 0,713, чувствительность – 45,63%, специфичность – 87,18. Для СХР выявлена значимая обратная корреляционная связь между СХР, по данным кистевого динамометра, и количественным показателем плотности паренхимы печени, по данным ТЭ (кПа) (r = -0,2879, p = 0,0005).

Выводы

Выводы. Наиболее высокую диагностическую точность при идентификации выраженного ФП и цирроза (F3-F4) показали индексы FIB-4 и NFS. Индексы FLI и ST продемонстрировали значимую диагностическую точность при идентификации выраженного стеатоза печени (S2-S3). СХР может использоваться как дополнительный неинвазивный метод, позволяющий отдифференцировать пациентов с выраженным фиброзом и циррозом печени (F3-F4).

Introduction

Introduction. Non-alcoholic fatty liver disease (NAFLD) is a global public health challenge. Study data show that all-cause mortality rates increase significantly with liver fibrosis F ≥ 2; therefore, predictive indices (PI) are critical for the primary diagnosis of liver fibrosis and steatosis.

Aim

Aim. To assess the diagnostic accuracy of steatosis (FLI, ST) and liver fibrosis (FIB-4, APRI, NFS) PI for detecting liver fibrosis and steatosis as compared with transient elastography (TE) in patients with NAFLD.

Materials and methods

Materials and methods. A total of 142 patients with NAFLD were included in the study. The computation of the above PI, TE-CAP was performed for all patients. The diagnostic accuracy of liver fibrosis and steatosis PI was compared with TE using a respondent-driven sampling. All patients underwent hand grip strength (HGS) measurement using a hand dynamometer.

Results

Results. The FIB-4 (cut-off point > 1.94) showed AUC = 0.643, a sensitivity of 34.78% and specificity of 90.62 for differentiation between severe LF and cirrhosis (F3-F4). The APRI (cut-off point > 0.44) showed AUC = 0.615, a sensitivity of 54.35%, and specificity of 67.71 for differentiation between severe LF and cirrhosis (F3-F4). The NFS (cut-off point > 26.38) showed AUC = 0.681, a sensitivity of 58.7% and specificity of 79.1 for differentiation between severe LF and cirrhosis (F3-F4). The ST (cut-off point > 0.054) showed AUC = 0.713, a sensitivity of 45.63% and specificity of 87.18 for differentiation of severe liver steatosis (S2-S3). For HGS, a significant inverse correlation between HGS, based on hand dynamometer values, and the quantitative indicator of liver parenchyma density, based on TE (kPa) values, was found (r = -0.2879, p = 0.0005).

Conclusions

Conclusions. The FIB-4 and NFS indices showed the highest diagnostic accuracy for detecting severe AF and cirrhosis (F3-F4). The FLI and ST indices demonstrated the significant diagnostic accuracy for detecting severe liver steatosis (S2-S3). HGS can be used as an additional non-invasive method for the differentiation of patients with severe fibrosis and cirrhosis (F3-F4).

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