Non-invasive fibrosis markers and elastography in diagnosis of fibrosis severity in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease

Authors

  • O. V. Zemlianitsyna SI “V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine”, Kharkiv,
  • V. M. Sinaiko Kharkiv National Medical University, Ukraine,
  • V. I. Savenkov Kharkiv National Medical University, Ukraine,
  • P. P. Kravchun Kharkiv National Medical University, Ukraine,
  • N. O. Kravchun SI “V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine”, Kharkiv,
  • O. O. Honcharova Kharkiv Medical Academy of Postgraduate Education, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2020.1.194497

Keywords:

fibrosis, elastography, type 2 diabetes mellitus, non-alcoholic fatty liver disease

Abstract

 

Objective: to evaluate the possibility of determining the stage of non-alcoholic fatty liver disease (NAFLD) with the help of indirect non-invasive markers of fibrosis and elastography.

Material and methods. The study involved 43 patients with type 2 diabetes mellitus (DM) and manifestation of NAFLD, including 26 (60.5 %) females and 17 (39.5 %) males. All the patients underwent an extensive ultrasound examination of the liver, namely determination of its size below the costal arch, a duplex examination to assess the distribution of hepatic vessels, determine possible blood flow trouble and its type. B-mode liver ultrasound with real-time elastography on Hitachi Hi Vision Avius apparatus was also performed. The presence and stage of fibrosis were assessed using the Bonacini discriminant score, METAVIR and Ishak scoring systems. A correlation analysis between results of various methods of liver fibrosis stage assessment in patients with type 2 DM and NAFLD was also conducted.

Results. Generally, in patients with type 2 DM and NAFLD, mild fibrosis (F0–F2) was diagnosed. The assessment of liver fibrosis intensity according to sonoelastography and other non-invasive methods (Bonacini, Ishak and METAVIR scores) gave comparable results. The results of liver fibrosis stage assessment in patients with type 2 DM and NAFLD according to sonoelastography were strongly correlated with the results of Bonacini classification (discriminant) score. The results of the Ishak and METAVIR scores were moderately correlated with the sonoelastography data and strongly correlated precisely in advanced stages of hepatic fibrosis.

Conclusions. The results obtained show the importance of criteria for NAFLD assessment in patients with type 2 DM, the need to determine NAFLD and liver fibrosis stages. The combination of ultrasound diagnosis, serum biomarkers and use of diagnostic scales is more informative and appropriate for assessing the liver fibrosis presence in patients with NAFLD, compared with separate use of these methods allowing reducing the frequency of invasive traumatic methods using.

 

References

International Diabetes Federation. (2017). IDF Diabetes Atlas (8th ed.). https://www.idf.org/our-activities/advocacy-awareness/resources-and-tools/134-idf-diabetes-atlas-8th-edition.html

Leite, N. C., Cardoso, C. R., Villela-Nogueira, C. A., & Salles, G. F. (2014). Non-alcoholic fatty liver disease and diabetes: From physiopathological interplay to diagnosis and treatment. World Journal of Gastroenterology, 20(26), 8377–8392. https://doi.org/10.3748/wjg.v20.i26.8377

Mukhalchuk, L. M., & Yefimov, A. S. (2010). Nealkoholna zhyrova khvoroba pechinky [Non-alcoholic fatty liver disease]. International journal of endocrinology, 2(26), 71–82. [in Ukrainian]. http://www.mif-ua.com/archive/article/12335

Vernon, G., Baranova, A., & Younossi, Z. M. (2011). Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Alimentary Pharmacology & Therapeutics, 34(3), 274–285. https://doi.org/10.1111/j.1365-2036.2011.04724.x

Crowley, M. J., Diamantidis, C. J., McDuffie, J. R., Cameron, C. B., Stanifer, J. W., Mock, C. K., Wang, X., Tang, S., Nagi, A., Kosinski, A. S., & Williams, J. W. (2017). Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease. Annals of Internal Medicine, 166(3), 191 200. https://doi.org/10.7326/m16-1901

Jellinger, P. S., Handelsman, Y., Rosenblit, P. D., Bloomgarden, Z. T., Fonseca, V. A., Garber, A. J., Grunberger, G., Guerin, C. K., Bell, D. S. H., Mechanick, J. I., Pessah-Pollack, R., Wyne, K., Smith, D., Brinton, E. A., Fazio, S., Davidson, M., Zangeneh, F., & Bush, M. A. (2017). American Association Of Clinical Endocrinologists And American College Of Endocrinology Guidelines For Management Of Dyslipidemia And Prevention Of Cardiovascular Disease - Executive Summary. Endocrine Practice, 23(4), 479–497. https://doi.org/10.4158/ep171764.gl

Buzzetti, E., Pinzani, M., & Tsochatzis, E. A. (2016). The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism, 65(8), 1038–1048. https://doi.org/10.1016/j.metabol.2015.12.012

Altinbas, A., Sowa, J. P., Hasenberg, T., & Canbay, A. (2015). The diagnosis and treatment of non-alcoholic fatty liver disease. Minerva gastroenterologica e dietologica, 61(3),159 169.

Gambino, R., Musso, G., & Cassader, M. (2011). Redox Balance in the Pathogenesis of Nonalcoholic Fatty Liver Disease: Mechanisms and Therapeutic Opportunities. Antioxidants & Redox Signaling, 15(5), 1325–1365. https://doi.org/15(5), 1325–1365

Chalasani, N., Younossi, Z., Lavine, J., Diehl, A., Brunt, E., Cusi, K., Charlton, M., & Sanyal, A. (2012). The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 55(6), 2005 2023. https://doi.org/10.1002/hep.25762

Doycheva, I., Cui, J., Nguyen, P., Costa, E. A., Hooker, J., Hofflich, H., Bettencourt, R., Brouha, S., Sirlin, C. B., & Loomba, R. (2016). Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Alimentary Pharmacology & Therapeutics, 43(1), 83–95. https://doi.org/10.1111/apt.13405

Brunt, E. M. (2017). Nonalcoholic fatty liver disease and the ongoing role of liver biopsy evaluation. Hepatology Communications, 1(5), 370–378. https://doi.org/10.1002/hep4.1055

Bedossa, P. (2018). Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: Why liver biopsy is essential. Liver International, 38(suppl. 1), 64 66. https://doi.org/10.1111/liv.13653

Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., Ferrell, L. D., Liu, Y.-C., Torbenson, M. S., Unalp-Arida, A., Yeh, M., McCullough, A. J., & Sanyal, A. J. (2005). Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology, 41(6), 1313–1321. https://doi.org/10.1002/hep.20701

Juluri, R., Vuppalanchi, R., Olson, J., Ünalp, A., Van Natta, M. L., Cummings, O. W., Tonascia, J., & Chalasani, N. (2011). Generalizability of the Nonalcoholic Steatohepatitis Clinical Research Network Histologic Scoring System for Nonalcoholic Fatty Liver Disease. Journal of Clinical Gastroenterology, 45(1), 55–58. https://doi.org/10.1097/mcg.0b013e3181dd1348

Knodell, R. G., Ishak, K. G., Black, W. C., Chen, T. S., Craig, R., Kaplowitz, N., Kiernan, T. W., & Wollman, J. (1981). Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology, 1(5), 431–435. https://doi.org/10.1002/hep.1840010511

Ishak, K., Baptista, A., Bianchi, L., Callea, F., De Groote, J., Gudat, F., Denk, H., Desmet, V., Korb, G., MacSween, R. N. M., Phillips, M. J., Portmann, B. G., Poulsen, H., Scheuer, P. J., Schmid, M., & Thaler, H. (1995). Histological grading and staging of chronic hepatitis. Journal of Hepatology, 22(6), 696–699. https://doi.org/10.1016/0168-8278(95)80226-6

Intraobserver and Interobserver Variations in Liver Biopsy Interpretation in Patients with Chronic Hepatitis C. (1994). Hepatology, 20(1), 15 20. https://doi.org/10.1002/hep.1840200104

Wieckowska, A., McCullough, A. J., & Feldstein, A. E. (2007). Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: Present and future. Hepatology, 46(2), 582–589. https://doi.org/10.1002/hep.21768

Yagmur, V. B., Yagmur, S. S., Kudryavceva, V. E., Melnichenko, L. Y., & Dementiy, N. P. (2012). Dinamika pokazatelei fibroza u bol'nykh tsirrozom pecheni pri lechenii s primeneniem ursodezoksikholevoi kisloty [Dynamics of fibrosis markers in patients with liver cirrhosis after treatment with ursodeoxycolic acid]. Gastroenterology, (46), 212 222 [in Russian].

Angulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., Enders, F., Saksena, S., Burt, A. D., Bida, J. P., Lindor, K., Sanderson, S. O., Lenzi, M., Adams, L. A., Kench, J., Therneau, T. M., & Day, C. P. (2007). The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology, 45(4), 846–854. https://doi.org/10.1002/hep.21496

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. (2016). Journal of Hepatology, 64(6), 1388–1402. https://doi.org/10.1016/j.jhep.2015.11.004

Goodman, Z. D. (2007). Grading and staging systems for inflammation and fibrosis in chronic liver diseases. Journal of Hepatology, 47(4), 598–607. https://doi.org/10.1016/j.jhep.2007.07.006

Downloads

How to Cite

1.
Zemlianitsyna OV, Sinaiko VM, Savenkov VI, Kravchun PP, Kravchun NO, Honcharova OO. Non-invasive fibrosis markers and elastography in diagnosis of fibrosis severity in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease. Zaporozhye medical journal [Internet]. 2020Feb.10 [cited 2024Apr.19];22(1). Available from: http://zmj.zsmu.edu.ua/article/view/194497

Issue

Vol. 22 No. 1 (2020)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)