Non-invasive diagnosis of fibrosis in patients with CHC and obesity

The aim of the study was to assess the possibilities of noninvasive diagnosis of liver fibrosis (FIB-4 and APRI indices) in patients with CHC and abdominal obesity.

Materials and methods. 52 men with CHC were examined. Genotype 1 was determined in 24 patients, genotype 3 in 19 patients and genotype 2 in 9 patients. According to the severity of fibrosis, patients with CHC were divided: without fibrosis (F0) - 12 patients, with weak fibrosis (F1) - 17 patients, with moderate fibrosis (F2) - 10 patients, with severe fibrosis (F3) - 8 patients, cirrhosis of the liver (F4) was detected in 5 patients. According to a liver biopsy, steatosis was found in 18 patients with CHC. Abdominal obesity was found in 34 patients with CHC. Non-invasive diagnosis of liver fibrosis was assessed using routine FIB-4 and APRI indices. The interval of values of FIB-4 and APRI, not related to the criteria for assessing the stage of fibrosis F3 and F4, we have conventionally designated as the «gray zone». The presence of insulin resistance was evaluated at HOMA-IR> 2.

Results. Key values of the FIB-4 index in patients with CHC and abdominal obesity were found significantly more often than when calculating the APRI index. Insulin resistance in patients with CHC and abdominal obesity was statistically significantly more frequent than in patients with CHC and without abdominal obesity. At stages F3-F4 in patients with CHC, abdominal obesity and insulin resistance, APRI values were recorded more often in the «gray zone»than FIB-4 values.

Conclusion. The FIB-4, APRI, HOMA-IR indices can be used in patients with CHC and abdominal obesity during the follow-up and dynamic monitoring of patients with CHC to highlight risk groups. FIB-4 was significantly more informative for determining the stage of fibrosis than APRI in patients with CHC and abdominal obesity with insulin resistance (HOMA-IR> 2).

1. Gusev D.A. Effektivnost’ zatrat na nalaprevir pri terapii hronicheskogo gepatita S (1 genotip) u pacientov, ne poluchavshih ranee protivovirusnye preparaty pri recidive zabolevaniya/ D.A Gusev, A.V. Rudakova, A.N. Uskov, i dr.// ZHurnal infektologii – 2016. – T. 8, №3. – S. 122–125.

2. ZHdanov K. V. Eliminaciya HCV-infekcii: istoriya s prodolzheniem/ K. V.ZHdanov, K. V. Kozlov, V.S. Sukachev i dr. // ZHurnal infektologii – 2018. – T. 10, №4. – S. 6–13.

3. ZHdanov K. V. Effektivnost’ i bezopasnost’ kombinacii ribavirina i pegilirovannogo interferona al’fa-2a u pacientov s hronicheskim gepatitom s: rezul’taty dvuh mul’ticentrovyh, prospektivnyh, otkrytyh, nesravnitel’nyh klinicheskih issledovanij/ K. V.ZHdanov, I.G. Bakulin, D.A. Gusev i dr. // ZHurnal infektologii – 2017. – T. 9, №4. – S. 59–68.

4. ZHdanov K. V. Effektivnost’ i bezopasnost’ protivovirusnoj terapii voennosluzhashchih, bol’nyh hronicheskim gepatitom S / K. V.ZHdanov, D. A. Gusev, K. V. Kozlov i dr. // Voenno-medicinskij zhurnal. – 2015. – T. 336, № 4. – S. 44–49.

5. ZHdanov K. V. Kliniko-patogeneticheskie aspekty sochetannyh gepatitov B i C / K.V. ZHdanov, D. A. Gusev, V. S. CHirskij, i dr. //Epidemiologiya i infekc. bolezni. – M., 2003. – №5.– S19–22.

6. ZHdanov K. V. Kliniko-immunologicheskie, virusologicheskie i morfologicheskie vzaimosvyazi pri hronicheskom virusnom gepatite S / K.V. ZHdanov, D. A. Gusev, V. S. CHirskij, i dr. //Vestn. Ros. Voen.-med. akad.– 2007.–T.18, №2. –S.78–82

7. ZHdanov K.V. Virusnye gepatity / K.V. ZHdanov, YU.V. Lobzin, D.A. Gusev, K.V. Kozlov. – SPb.: Foliant, 2011. – 304 s.

8. ZHdanov K.V. Latentnye formy virusnyh gepatitov V i S u lic molodogo vozrasta: Avtoref. dis. … d-ra med. nauk / K.V. ZHdanov. – SPb., 2000. – 44 c.

9. ZHdanov K.V. Gepatit S i nealkogol’naya zhirovaya bolezn’ pecheni u pacientov s VICH-infekciej / K.V. ZHdanov, K.V. Kozlov, V.S. Sukachev// VICH-infekciya i immunosupressii.– 2017.– T. 9. № 1. – S. 36–42.

10. ZHdanov K.V., Gusev D.A., Zaharenko S.M., Kozlov K.V., Sigidaev A.S., Kurtukov M.V., Sukachev V.S. Sindrom izbytochnogo bakterial’nogo rosta u bol’nyh hronicheskim gepatitom S/ K.V. ZHdanov, D.A. Gusev, Zaharenko S.M., i dr. // ZHurnal infektologii. –2011. –T. 3. № 4. – S. 98–101.

11. Kozlov K.V. Hronicheskie virusnye gepatity: klinika, diagnostika, lechenie, nablyudenie i ekspertiza v voenno-medicinskih uchrezhdeniyah. Avtoref. dis. … d-ra med. nauk / K.V. Kozlov. – SPb., 2015. – 32 c.

12. Klinicheskie rekomendacii EASL-EASD-EASO po diagnostike i lecheniyu nealkogol’noj zhirovoj bolezni pecheni // J. Hepatol. Russkoe izdanie. – 2016. –T.2, №5. – S. 52–70.

13. Maev I.V. Sovremennye i perspektivnye podhody k diagnostike nealkogol’noj zhirovoj bolezni pecheni / I.V.Maev, E.I.Kuznecova, D.N.Andreev i dr.// CONSILIUM MEDICUM.– 2015.– VOL. 17, N 8.– C. 20–27.

14. Ratziu V. Kogda put’ ot ozhireniya k cirrozu nachinaetsya rano / V. Ratziu, Marchezini D. // J. Hepatol. Russkoe izdanie. – 2016. –T.2, №6. – S. 6–9.

15. Sukachev V.S. Ocenka morfofunkcional’nogo sostoyaniya tonkoj kishki u bol’nyh hronicheskim gepatitom S: Avtoref. dis.. kand. med. nauk / V.S. Sukachev. – SPb.,2012. – 13 s.

16. Suhoruk A.A. Cirroz pecheni kak iskhod hronicheskogo gepatita S / A.A. Suhoruk , E.V.Esaulenko, O.A. Gerasimova // ZHurnal infektologii. – 2014. – № 1. – S. 67 – 71.

17. Trifonova G.F. Ostryj i hronicheskij gepatit S v Rossijskoj Federacii v 1994–2013 gg / G.F. Trifonova, I.A. Levakova, D.D. Bolsun i dr.// Infekciya i immunitet. – 2014. –T. 4. № 3. – S. 267–274.

18. Harrison S.A. Rezistentnost’ k insulinu u bol’nyh hronicheskim gepatitom S: ee etiologiya i vliyanie na taktiku lecheniya/ S.A. Harrison // J. Clinical Gastroenterology and Hepatology. Russkoe izdanie.–2008.–T.1,№5.–S. 310–332.

19. Esaulenko E.V., Hronicheskij virusnyj gepatit C v SeveroZapadnom federal’nom okruge / E.V Esaulenko, A.A. Suhoruk, M.V. Ponyatishina i dr.// VICH-infekciya i immunosupressii. –2017. – T.9. №2. – S.74-81. https://doi.org/10.22328/20779828-2017-9-2-74-81

20. Berzigottia A., Ashkenazia E., Revertera E., et al. Noninvasive diagnostic and prognostic evaluation of liver cirrhosis and portal hypertension. Dis Markers 2011; 31(3):129–38.

21. Lazo M, Hernaez R, Eberhardt MS, et al Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2013;178:38–45.

22. Sigrist R.M.S., Liau J., Kaffas A. El., et al. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7(5):1303–29.

23. Toouli J., Fried M., Khan A G., et al. WGO Global Guideline Obesity [Internet]. 2009. Available from: http:// www. Worldgastroenterology. org/UserFiles/file/guidelines/ obesity-russian-2009.pdf