jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2020-12-1-73-79jofin-1015Research ArticleОригинальные исследованияOriginal ResearchДиагностическое значение непрямых маркеров фиброза печени у пациентов с хроническим гепатитом ВThe diagnostic value of indirect markers of liver fibrosis in patients with chronic hepatitis BТерешковД. В.TereshkovD. V.

Терешков Дмитрий Валерьевич – заведующий инфекционным отделением.

Гомель, тел.: +375-447-26-95-19

Gomel

tereshkovd@tut.byМицураВ. М.MitsuraV. M.

Мицура Виктор Михайлович – декан медико-диагностического факультета, профессор кафедры инфекционных болезней, д.м.н., доцент.

 Гомель, тел.: +375-296-47-17-10

Gomel

mitsura_victor@tut.byГомельская областная инфекционная клиническая больницаБеларусьGomel Regional Infectious Clinical HospitalBelarusГомельский государственный медицинский университетБеларусьGomel State Medical UniversityBelarus2020190320201217379Copyright © Терешков Д.В., Мицура В.М., 20202020Терешков Д.В., Мицура В.М.Tereshkov D.V., Mitsura V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1015Цель

Цель: оценить возможность использования непрямых маркеров и рассчитанных на их основе индексов при определении выраженности фиброза печени для проведения динамического мониторинга прогрессирования фиброза и своевременного назначения противовирусной терапии пациентам с хроническим гепатитом В.

Материалы и методы

Материалы и методы: обследовано 130 пациентов с хроническим гепатитом В (средний возраст 41,8±13,5 лет, 70% мужчин) с известной степенью выраженности фиброза на основании фиброэластометрии либо биопсии печени. Учитывались возраст пациентов, 9 показателей биохимического анализа крови, гемограммы и коагулограммы, а также 7 индексов, рассчитанных на их основе. Прогностическая значимость непрямых показателей фиброза и индексов оценивалась с помощью ROC-анализа.

Результаты

Результаты: с нарастанием стадии фиброза печени в периферической крови снижается уровень альбумина, протромбинового индекса, тромбоцитов, холестерина, повышается уровень аспартатаминотрансферазы, международного нормализованного отношения, гаммаглутамилтранспептидазы, аланинаминотрансферазы, щелочной фосфатазы (p<0,01). Все лабораторные показатели и индексы значимо различаются у пациентов с минимальным (F0–F1) и выраженным (F2–F4) фиброзом печени (р<0,01). Наиболее прогностически значимы для определения выраженного фиброза печени индексы GUCI, King’s score и шкала eLIFT, а наиболее информативным (площадь под характеристической кривой 0,866) с чувствительностью 89,5% и специфичностью 78,0% при точке разделения ≥0,7 является индекс GUCI.

Заключение

Заключение: исследование непрямых маркеров фиброза печени легко выполнимо на любом этапе оказания медицинской помощи и может использоваться для проведения динамического мониторинга прогрессирования фиброза и определения показаний к противовирусной терапии у пациентов с хроническим гепатитом В.

Aim of investigation

Aim of investigation: The aim of the present study was to evaluate the possibility using of indirect liver fibrosis markers for the estimation of fibrosis severity and timely prescribing of antiviral therapy in patients with chronic hepatitis B.

Materials and methods

Materials and methods: We examined 130 patients with chronic hepatitis B (mean age 41,8±13,5 years, 70% of men) having known liver fibrosis stage based on fibroelastography or liver biopsy. The age of patients, 9 parameters of biochemical blood analysis, complete blood count and coagulogram along with 7 indices calculated on their base were considered. Their prognostic values were estimated by means of ROC analysis.

Results

Results: According to increase of liver fibrosis stage albumin, prothrombin index, platelet count, cholesterol reduce and aspartate aminotransferase, international normalized ratio, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase levels rise (p<0,01). All of the laboratory parameters and indices were significantly different (p<0,01) in patients with minimal (F0–F1) and advanced (F2–F4) fibrosis. For patients with chronic hepatitis B the most significant predictors of advanced liver fibrosis (F2–F4) were: GUCI and King’s score indices as well as eLIFT scale. Index GUCI had the best diagnostic performance (area under the receiver operating characteristic curve 0,866) with 89,5% sensitivity and 78,0% specificity at cut off ≥0,7/

Conclusion

Conclusion: The assessment of indirect liver fibrosis markers in patients with chronic hepatitis B can be easily performed at any stage of medical care; they are quite informative and can be used for the estimation of fibrosis severity and timely conducting antiviral therapy.

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