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