medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-218medsovet-9176Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERВалидация шкал FibroScan-AST (FAST) и Agile 3+ при метаболически ассоциированной болезни печени на российской когорте пациентовValidation of the FibroScan-AST (FAST) and Agile 3+ score in metabolic dysfunction-associated steatotic liver disease in a Russian cohort of patientshttps://orcid.org/0000-0001-8159-9745ГомоноваВ. П.GomonovaV. P.

Гомонова Вероника Павловна, ассистент научно-клинического и образовательного центра гастроэнтерологии и гепатологии Медицинского института

199034, Санкт-Петербург, Университетская наб., д. 7/9

Veronika P. Gomonova, Assistant, Clinical Research and Education Centre for Gastroenterology and Hepatology, Medical Institute

7–9, Universitetskaya Emb., St Petersburg, 199034

veronikakovyazina@yandex.ruhttps://orcid.org/0000-0002-8821-6142РайхельсонК. Л.RaikhelsonK. L.

Райхельсон Карина Леонидовна, д.м.н., профессор научно-клинического и образовательного центра гастроэнтерологии и гепатологии Медицинского института, Санкт-Петербургский государственный университет; профессор кафедры общей врачебной практики, Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова

199034, Санкт-Петербург, Университетская наб., д. 7/9,

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Karina L. Raikhelson, Dr. Sci. (Med.), Professor of the Clinical Research and Education Centre for Gastroenterology and Hepatology, Medical Institute, St Petersburg State University; Professor of the Department of General Medical Practice, Pavlov First Saint Petersburg State Medical University

7–9, Universitetskaya Emb., St Petersburg, 199034,

6–8, Lev Tolstoy St., St Petersburg, 197022

kraikhelson@mail.ruhttps://orcid.org/0000-0002-4958-5850КащенкоВ. А.KashchenkoV. A.

Кащенко Виктор Анатольевич, д.м.н., профессор, заведующий кафедрой факультетской хирургии, Санкт-Петербургский государственный университет; заместитель генерального директора по научно-образовательной работе, Северо-Западный окружной научно-клинический центр имени Л.Г. Соколова Федерального медико-биологического агентства; заместитель главного врача по хирургии, Клиника высоких технологий «Белоостров»

199034, Санкт-Петербург, Университетская наб., д. 7/9,

194291, Санкт-Петербург, проспект Культуры, д. 4,

188640, Ленинградская обл., Всеволожский мкр-н, с. п. Юкковское, зд. 1, корп. 1

Victor A. Kashchenko, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery, St Petersburg State University; Deputy General Director for Research, North-Western District Scientific and Clinical Center named after L.G. Sokolov; Deputy Chief Physician for Surgery, Beloostrov Clinic of High Technologies

7–9, Universitetskaya Emb., St Petersburg, 199034,

4, Kultury Ave., St Petersburg, 194291,

1, Bldg. 1, Yukkovskoe rural settlement, Vsevolozhsk District, Leningrad Region, 188640

surg122@yandex.ruhttps://orcid.org/0000-0002-5535-6915ЛодыгинА. В.LodyginA. V.

Лодыгин Александр Владимирович, к.м.н., доцент кафедры факультетской хирургии, Санкт-Петербургский государственный университет; заведующий 1-м хирургическим отделением, Северо-Западный окружной научно-клинический центр имени Л.Г. Соколова Федерального медико-биологического агентства

199034, Санкт-Петербург, Университетская наб., д. 7/9,

194291, Санкт-Петербург, проспект Культуры, д. 

Aleksandr V. Lodygin, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery, St Petersburg State University; Head of the 1st Surgical Department, North-Western District Scientific and Clinical Center named after L.G. Sokolov

7–9, Universitetskaya Emb., St Petersburg, 199034,

4, Kultury Ave., St Petersburg, 194291

alexlod@mail.ruhttps://orcid.org/0000-0002-7972-1286КаревВ. Е.KarevV. E.

Карев Вадим Евгеньевич, д.м.н., ведущий научный сотрудник, руководитель отдела тканевых и патоморфологических методов исследования, заведующий лабораторией патоморфологии клиники, Детский научно-клинический центр инфекционных болезней Федерального медико-биологического агентства; профессор научно-клинического и образовательного центра гастроэнтерологии и гепатологии Медицинского института, Санкт-Петербургский государственный университет

197022, Санкт-Петербург, ул. Профессора Попова, д. 9u,

199034, Санкт-Петербург, Университетская наб., д. 7/9,

 

Vadim E. Karev, Dr. Sci. (Med.), Leading Researcher, Head of the Research Clinical Department of Tissue and Pathomorphological Research Methods, Head of the Clinic’s Pathomorphology Laboratory, Pediatric Research and Clinical Center for Infectious Diseases, Federal Medical-Biological Agency; Professor of the Clinical Research and Education Centre for Gastroenterology and Hepatology, Medical Institute, St Petersburg State University

9g, Professor Popov St., St Petersburg, 197022,

7–9, Universitetskaya Emb., St Petersburg, 199034

 

vadimkarev@yandex.ruСанкт-Петербургский государственный университетРоссияSt Petersburg State UniversityRussian FederationСанкт-Петербургский государственный университет; Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаРоссияSt Petersburg State University; Pavlov First Saint Petersburg State Medical UniversityRussian FederationСанкт-Петербургский государственный университет; Северо-Западный окружной научно-клинический центр имени Л.Г. Соколова Федерального медико-биологического агентства; Клиника высоких технологий «Белоостров»РоссияSt Petersburg State University; North-Western District Scientific and Clinical Center named after L.G. Sokolov; Beloostrov Clinic of High TechnologiesRussian FederationСанкт-Петербургский государственный университет; Северо-Западный окружной научно-клинический центр имени Л.Г. Соколова Федерального медико-биологического агентстваРоссияSt Petersburg State University; North-Western District Scientific and Clinical Center named after L.G. SokolovRussian FederationСанкт-Петербургский государственный университет; Детский научно-клинический центр инфекционных болезней Федерального медико-биологического агентстваРоссияSt Petersburg State University; Pediatric Research and Clinical Center for Infectious Diseases, Federal Medical-Biological AgencyRussian Federation20251806202508134143Copyright © Гомонова В.П., Райхельсон К.Л., Кащенко В.А., Лодыгин А.В., Карев В.Е., 20252025Гомонова В.П., Райхельсон К.Л., Кащенко В.А., Лодыгин А.В., Карев В.Е.Gomonova V.P., Raikhelson K.L., Kashchenko V.A., Lodygin A.V., Karev V.E.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/9176Введение

Введение. Высокая распространенность метаболически ассоциированной жировой болезни печени (МАЖБП) требует своевременной диагностики ее прогрессирующих форм. Недавно разработанные для этой цели индексы FibroScan-AST (FAST) и Agile 3+ показали хорошие диагностические возможности, однако валидация на российской когорте не проводилась.

Цель

Цель. Оценить диагностическую эффективность шкал FAST и Agile 3+ у российских пациентов с МАЖБП.

Материалы и методы

Материалы и методы. Проанализирована медицинская документация 43 пациентов с гистологически верифицированной МАЖБП и выполненной транзиентной эластографией (ТЭ). Рассчитывались неинвазивные индексы прогрессирующего течения МАЖБП: FIB-4, FAST и Agile 3+.

Результаты

Результаты. Все исследуемые методы продемонстрировали хорошую диагностическую способность. FAST показала наилучшие результаты для выявления неалкогольного стеатогепатита (НАСГ) + NAS ≥ 4 + F ≥ 2 в сравнении с ТЭ и FIB-4 (площадь под ROC-кривой (area under the ROC Curve, AUROC)) для FAST составила 0,827 ± 0,064 (95% ДИ: 0,701–0,952, р < 0,0001); для FIB-4 и ТЭ – 0,786 ± 0,069 (95% ДИ: 0,651–0,920, р = 0,001) и 0,758 ± 0,075 (95% ДИ: 0,610–0,905, р = 0,004) соответственно. Однако стандартные пороговые значения FAST (≤0,35 и ≥0,67) имели низкую чувствительность у исследуемой когорты: число неопределенных результатов составило 60,5%. Оптимизация пороговых значений FAST (≤0,41 и ≥0,52) позволила уменьшить долю неопределенных случаев до 23,25% и увеличить число правильно классифицированных пациентов (с 37,2 до 62,8%, p = 0,0012). Для диагностики прогрессирующего фиброза (F ≥ 3) шкала Agile 3+ показала наилучший результат (AUROC = 0,825 ± 0,077 (95% ДИ: 0,675–0,976, р = 0,003) по сравнению с FIB-4 и ТЭ, но пересчет пороговых значений не привел к значимому улучшению диагностической способности модели.

Выводы

Выводы. Шкалы FAST и Agile 3+ эффективны для диагностики прогрессирующего течения МАЖБП, однако пороговые значения FAST требуют адаптации для российской популяции.

Introduction

Introduction. The high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) requires timely diagnosis of its progressive forms. Recently developed for this purpose FibroScan-AST (FAST) and Agile 3+ indices have shown good diagnostic capabilities, but have not been validated in a Russian cohort.

Aim

Aim. To evaluate the diagnostic efficiency of the FAST and Agile 3+ scores in Russian patients with MASLD.

Materials and methods

Materials and methods. The medical records of 43 patients with histologically verified MASLD and transient elastography (TE) performed were analyzed. Non-invasive indices of progressive MASLD were calculated: FIB-4, FAST and Agile 3+.

Results

Results. All the studied methods demonstrated good diagnostic ability. FAST demonstrated the best results for detecting non-alcoholic steatohepatitis (NASH) + NAS ≥ 4 + F ≥ 2 compared to TE and FIB-4. The area under the ROC curve (AUROC) for FAST was 0.827 ± 0.064 (95% CI: 0.701–0.952, p < 0.0001); for FIB-4 and TE – 0.786 ± 0.069 (95% CI: 0.651–0.920, p = 0.001) and 0.758 ± 0.075 (95% CI: 0.610–0.905, p = 0.004), respectively. However, the standard FAST cutoff values (≤0.35 and ≥0.67) had low sensitivity in the study cohort: the number of indeterminate results was 60.5%. Optimization of the FAST cutoff values (≤0.41 and ≥0.52) reduced the proportion of indeterminate cases to 23.25% and increased the number of correctly classified patients (from 37.2% to 62.8%, p = 0.0012). For the diagnosis of progressive fibrosis (F ≥ 3), the Agile 3+ score showed the best result (AUROC = 0.825 ± 0.077 (95% CI: 0.675–0.976, p = 0.003)) compared to FIB-4 and TE, but recalculation of the threshold values did not lead to a significant improvement in the diagnostic ability of the Agile 3+.

Conclusions

Conclusions. The FAST and Agile 3+ scores are effective for diagnosing progressive MASLD, but the FAST threshold values require adaptation for the Russian population.

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