Метаболически ассоциированная жировая болезнь печени у больных пожилого возраста: неинвазивная диагностика и методы оценки фиброза печени

Метаболически ассоциированная жировая болезнь печени является одной из самых распространенных патологий печени в мире, которая варьирует от простого стеатоза до более тяжелых форм, таких как стеатогепатит, который может прогрессировать до фиброза печени, цирроза и гепатоцеллюлярной карциномы. Степень фиброза в печеночной ткани связана с повышенным риском общей смертности, сердечно-сосудистых заболеваний, гепатоцеллюлярной карциномы и внепеченочных злокачественных новообразований, особенно у лиц пожилого возраста, когда увеличивается предрасположенность к метаболическим расстройствам, что может привести к развитию жировой дистрофии печени и прогрессированию фиброза. Гистологические методы исследования печени, в том числе биопсии печени, обладают высокой информативностью и благодаря чему этот способ диагностики патологии печени имеет решающее значение в верификации диагноза, однако данные процедуры могут иметь редкие, но потенциально серьезные осложнения. В связи с этим не вызывает сомнения актуальность использования различных неинвазивных методов оценки выраженности фибротических процессов в печеночной ткани, включая существующие шкалы и алгоритмы, такие как FIB-4 и NAFLD Fibrosis Score, шкалы BARD и BAAT, индекс APRI и ультразвуковую эластографию. В данном обзорном исследовании рассматриваются возможности использования современных неинвазивных подходов оценки степени фиброза у пациентов с метаболически ассоциированной жировой болезнью печени, в том числе и у больных пожилого возраста. Таким образом, в качестве первого шага весьма актуальным является использование расчетных индексов фиброза, таких как индекс FIB-4, шкала NFS, с последующим при необходимости применением ультразвуковых методов диагностики особенно эластографии печени.

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