Single article

DOI: 10.47026/2413-4864-2022-4-12-26

Venidiktova D.Yu., Borsukov A.V.

On the Issue of Liver Biopsy in Patients with Metabolically Associated Fatty Liver Disease

Keywords: biopsy, reference method, metabolically associated fatty liver disease

The aim of the work was to evaluate the possibility of replacing liver biopsy with other methods of examination in patients with metabolically associated fatty liver disease. All patients were examined according to a single diagnostic algorithm consisting of four stages: physical, laboratory, instrumental (using non-invasive bioimpedansometry, multiparametric ultrasound examination, dual-energy X-ray absorptiometry in the "Whole body" mode, computer and magnetic resonance imaging), histological (evaluation of liver micropreparations on the SAF scale). the patients were divided into three groups, taking into account the results of histological examination of biopsies on the SAF scale: group 1 – patients with hepatic steatosis without signs of inflammation, fibrosis (n = 56, 53.9%); group 2 – patients with steatohepatitis and clinically insignificant hepatic fibrosis F0-F1 (n = 30, 28.8%); group 3 – patients with steatohepatitis and clinically significant liver fibrosis F2-F3 (n = 16, 15.4%). the correlation of findings obtained by the histological examination of liver biopsies and the data of ultrasound quantitative liver steatometry is high – r = 0.95 (for liver steatosis S1), r = 0.84 (for liver steatosis S2), r = 0.91 (for liver steatosis S3); ultrasonic shear wave elastography – r = 0.84 (for clinically insignificant liver fibrosis F0-F1), r = 0.88 (for clinically significant liver fibrosis F2-F3). the data obtained using dual-energy X-ray absorptiometry in the "Whole Body" mode quantitatively reflect the state of the patient's metabolic status, they can be evaluated in dynamics due to low radiation load. Thus, the diagnostic complex consisting of assessing the level of hepatic transaminases, multiparametric ultrasound examination and dual-energy X-ray absorptiometry in the "Whole body" mode is optimal to examine the patients who have contraindications to liver biopsy or completely refuse to pass this study. in case of the patient's consent, absence of contraindications, as well as in the presence of a number of diffuse liver diseases, histological examination is recommended to identify and to assess in detail the dystrophic, inflammatory, sclerotic, regenerative processes.

References

  1. Ahmedov V.A., Gaus O.V. Sovremennye vozmozhnosti neinvazivnogo prognoza fibroza pecheni u patsientov s nealkogolnoi zhirovoi bolezniu pecheni [Modern possibilities of noninvasive prognosis of liver fibrosis in patients with non-alcoholic fatty liver disease]. Gastroenterologiya SanktPeterburga, 2018, no.3, pp. 19–24.
  2. Babenko A.Yu., Laevskaya M.Yu. Nealkogolnaia zhirovaia boleznpechenivzaimosvyazi s metabolicheskim sindromom [Non–alcoholic fatty liver disease – interrelations with metabolic syndrome]. Russkii meditsinskii zhurnal, 2018, vol.26, no. 1-1, pp. 34–40.
  3. Borsukov A.V., Venidiktova D.Yu. Otsenka sravnitel’noi effektivnosti metodov instrumental’noi diagnostiki steatoza pecheni u patsientov s metabolicheskim sindromom [Evaluation of the comparative effectiveness of methods of instrumental diagnosis of liver steatosis in patients with metabolic syndrome]. Prakticheskaya meditsina, 2018, vol. 16, no. 2, pp. 16–21.
  4. Borsukov A.V., Bueverov A.O., Tikhankova A.V. Kontrast-usilennoe ul’trazvukovoe issledovanie pri diffuznykh zabolevaniyakh pecheni [Contrast-enhanced ultrasound examination in diffuse liver diseases]. Smolensk, 2020, 35 p.
  5. Gonchar A.P., Gombolevskii V.A., Elizarov A.B. Sravnitel’nyi analiz plotnosti pecheni po dannym KT i nizkodoznoi KT organov grudnoi kletki [Comparative analysis of liver density according to CT and low-dose CT of the chest organs]. Meditsinskaya vizualizatsiia, 2020, vol. 24, no. 1, pp. 39–47.
  6. Dudanova O.P., Shipovskaya A.A., Kurbatova I.V. Markery pechenochno-kletochnogo povrezhdeniya i vospaleniya pri rannei forme nealkogol’noi zhirovoi bolezni pecheni [Markers of hepatic cell damage and inflammation in the early form of non-alcoholic fatty liver disease]. Gastroenterologiya Sankt-Peterburga, 2017, no. 3, pp. 16–20.
  7. Ivashkin V.T. et al. Klinicheskie rekomendatsii po diagnostike i lecheniyu nealkogol’noi zhirovoi bolezni pecheni Rossiiskogo obshhestva po izucheniyu pecheni i Rossiiskoi gastroenterologicheskoi assotsiatsii [Clinical recommendations for the diagnosis and treatment of non-alcoholic fatty liver disease of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii, 2016, vol. 26, no. 2, pp. 24–42.
  8. Klinicheskie rekomendacii po vedeniyu bol’nykh s metabolicheskim sindromom Ministerstva Zdravookhraneniya Rossiiskoi Federatsii [Clinical guidelines for the management of patients with metabolic syndrome of the Ministry of Health of the Russian Federation]. Moscow, 2013, 43 p.
  9. Lazebnik L.B. et al. Nealkogol’naya zhirovaya bolezn’ pecheni u vzroslykh: klinika, diagnostika, lechenie. Rekomendacii dlya terapevtov, tret’ya versiya. [Non-alcoholic fatty liver disease in adults: clinic, diagnosis, treatment. Recommendations for therapists, the third version]. Eksperimental’naya i klinicheskaya gastroenterologiya, 2021, no. 1, pp. 4–52.
  10. Marshalko D.V., Pchelin I.Yu., Shishkin A.N. Nealkogol’naya zhirovaya bolezn’ pecheni: komorbidnost’, klinicheskoe znachenie i metody diagnostiki fibroza pecheni [Nonalcoholic fatty liver disease: comorbidity, clinical significance and methods of diagnosis of liver fibrosis]. Juvenis scientia, 2018, no. 2, pp. 14–17.
  11. Trukhacheva N.V. Matematicheskaya statistika v mediko-biologicheskikh issledovaniyakh s primeneniem paketa Statistica [Mathematical statistics in biomedical research using the Statistica package]. Moscow,2012, 384 p.
  12. Shipovskaya A.A., Dudanova O.P., Kurbatova I.V. Klinicheskoe znachenie insulinorezistentnosti u nediabeticheskikh patsientov s rannimi formami nealkogol’noy zhirovoy bolezni pecheni [Clinical significance of insulin resistance in nondiabetic patients with early forms of non-alcoholic fatty liver disease]. Terapevticheskii arkhiv, 2018, vol. 90, no. 8, pp. 63–68.
  13. Shhekotova A.P., Bulatova I.A., Shekotov I.V. Neinvazivnye laboratornye testy diagnostiki fibroza pecheni [Noninvasive laboratory tests for the diagnosis of liver fibrosis]. Sovremennye problemy nauki i obrazovaniya, 2017, no. 1, pp. 60–68.
  14. Al-Sofiani M.E., Ganji S.S., Kalyani R.R. Body composition changes in diabetes and aging. Journal of Diabetes and its Complications, 2019, vol. 33, no. 6, pp. 451−459.
  15. Ballestri S., Tana C., Girolama M., et al. Semi-quantitative Ultrasonographic Evaluation of NAFLD. Current pharmaceutical design, 2020, vol. 26, no. 32, pp. 3915−3927.
  16. Bartlett J.D., Hatfiels M., Parker B.B. et al. DXA-derived estimates of energy balance and its relationship with changes in body composition across a season in team sport athletes. European journal of sport science, 2019, vol. 20, no. 7, pp. 859−867.
  17. Bedossa P. Current histological classification of NAFLD: strength and limitations. International, 2013, vol. 7, no. 2, pp. 765−770.
  18. Borkan G.A., Gerzof S.G., Robbins A.H. et al. Assessment of abdominal fat content by computed tomography. the American journal of clinical nutrition, 1982, vol. 36, no. 1, pp. 172−177.
  19. Bredella M.A., Ghomi R.H., Thomas B.J., et al. Comparison of DXA and CT in the assessment of body composition in premenopausal women with obesity and anorexia nervosa. Obesity, 2010, vol. 18, no. 11, pp. 2227−2233.
  20. Brodie D., Vicki M.S., Hutcheion R. Body composition measurement: a review of hydrodensitometry, anthropometry, and impedance methods. Nutrition, 1998, vol. 14, no. 3, pp. 296−310.
  21. Celsa C. Biochemical Biomarkers of NAFLD/NASH. NAFLD and NASH Springer, 2020, pp. 89−114.
  22. Crabtree C.D. Quantification of Human Central Adipose Tissue Depots: an Anatomically Matched Comparison Between DXA and MRI. Tomography, 2019, vol. 5, no. 4, pp. 358−366.
  23. Eslam M, Newsome P.N., Anstee Q.M., et al. a new definition for metabolic associated fatty liver disease: an international expert consensus statement. Journal of Hepatology, 2020, pp. 202−209.
  24. Eslam M., Sanyal A.J., George J. MAFLD: a consensus driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology, 2020, p. 1999−2014.
  25. Falck-Ytter Y., McCullough A.J., Cadranel J.F., et al. the risks of percutaneous liver biopsy. Journal of Hepatology, 2001, vol. 33, no. 1, pp. 764−764.
  26. Fouad Y., Waked I., Bollipo S., et al. What’s in a name? Renaming ‘NAFLD’to ‘MAFLD’. Liver International, 2020, vol. 40, no. 6, pp. 1254−1261.
  27. Gadekar T. Correlation of visceral body fat with waist–hip ratio, waist circumference and body mass index in healthy adults: a cross sectional study. Medical Journal Armed Forces India, 2020, vol. 76, no. 1, pp. 41−46.
  28. Gerhardt F. Biopsy rate and nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD). Scandinavian Journal of Gastroenterology, 2020, pp. 1−6.
  29. Graffy P.M., Pickhardt P.J. Quantification of hepatic and visceral fat by CT and MR imaging: relevance to the obesity epidemic, metabolic syndrome and NAFLD. the British journal of radiology, 2016, vol. 89, no. 1062, pp. 1−10.
  30. Gunn N., Shiffman M.L. the use of liver biopsy in nonalcoholic fatty liver disease: when to biopsy and in whom. Clinics in Liver Disease, 2018, vol. 22, no. 1, pp. 109−119.
  31. Huwart L., Sempoux C., Vicaut E. et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology, 2008, vol. 135, pp. 32−40.
  32. Karlas T. Non-invasive assessment of hepatic steatosis in patients with NAFLD using controlled attenuation parameter and 1 H-MR spectroscopy. PloS one, 2014, vol. 9, no. 3, pp. 91−98.

About authors

Venidiktova Daria Yu.
Candidate of Medical Sciences, Senior Scientist, Fundamental Research Laboratory «Diagnostic Research and Minimally Invasive Techniques», Smolensk State Medical University, Russia, Smolensk (daria@venidiktova.ru; ORCID: https://orcid.org/0000-0001-5497-1476)
Borsukov Aleksey V.
Doctor of Medical Sciences, Professor, Director of the Problem Research Laboratory «Diagnostic Research and Minimally Invasive Technologies», Smolensk State Medical University, Russia, Smolensk (bor55@yandex.ru; ORCID: https://orcid.org/0000-0003-4047-7252)

Article link

Venidiktova D.Yu., Borsukov A.V. On the Issue of Liver Biopsy in Patients with Metabolically Associated Fatty Liver Disease [Electronic resource] // Acta medica Eurasica. – 2022. – №4. P. 12-26. – URL: https://acta-medica-eurasica.ru/en/single/2022/4/2/. DOI: 10.47026/2413-4864-2022-4-12-26.