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Неалкогольный стеатогепатит: проблема своевременной диагностики
Полухина А.В., Винницкая Е.В., Хайменова Т.Ю., Сандлер Ю.Г. Неалкогольный стеатогепатит: проблема своевременной диагностики. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2018; 1: 23–29. DOI: 10.26442/2414-3529_2018.1.23-29
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Polukhina A.V., Vinnitskaya E.V., Haimenova T.Yu., Sandler Yu.G. Nonalcoholic steatohepatitis: the problem of modern diagnosis. Gastroenterology (Suppl. Consilium Medicum). 2018; 1: 23–29. DOI: 10.26442/2414-3529_2018.1.23-29
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Аннотация
В статье приводятся данные об эпидемиологии неалкогольной жировой болезни печени, в том числе в отдельных группах больных, обзор методов диагностики и терапии. Рассмотрены преимущества неинвазивных методов обследования, их область применения и возможности использования для скрининга в группах риска.
Ключевые слова: неалкогольная жировая болезнь печени, стеатоз печени, неалкогольный стеатогепатит, эластометрия печени, ФиброМакс.
Ключевые слова: неалкогольная жировая болезнь печени, стеатоз печени, неалкогольный стеатогепатит, эластометрия печени, ФиброМакс.
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The article presents data on the epidemiology of nonalcoholic fatty liver disease, including in certain groups of patients, a review of diagnostic methods and therapy. The article describes the advantages of non-invasive methods of examination, their scope and the possibility of using for screening in risk groups.
Key words: nonalcoholic fatty liver disease, fatty liver, nonalcoholic steatohepatitis, liver elastometry, FibroMax.
Полный текст
Список литературы
1. Smith BW, Adams LA. Non-alcoholic fatty liver disease. Crit Rev Clin Lab Sci 2011; 8: 97–113.
2. Бакулин И.Г., Сандлер Ю.Г., Винницкая Е.В. и др. Оценка стеатоза печени с помощью неинвазивного метода: миф или реальность? Доктор.Ру. Гастроэнтерология. 2015; 12: 57–64. / Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Otsenka steatoza pecheni s pomoshch'iu neinvazivnogo metoda: mif ili real'nost'? Doktor.Ru. Gastroenterologiia. 2015; 12: 57–64. [in Russian]
3. Бакулин И.Г., Сандлер Ю.Г., Кейян В.А., Ротин Д.Л. Новый неинвазивный метод оценки стеатоза при хронических заболеваниях печени. Терапевт. арх. 2016; 88 (2): 49–57. / Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
4. Драпкина О.М., Ивашкин В.Т. Эпидемиологические особенности неалкогольной жировой болезни печени в России. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2014; 4: 32–8. / Drapkina O.M., Ivashkin V.T. Epidemiologicheskie osobennosti nealkogol'noi zhirovoi bolezni pecheni v Rossii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2014; 4: 32–8. [in Russian]
5. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 17–49.
6. Fassio E, Alvarez E, Domínguez N et al. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004; 40 (4): 820–6.
7. Compare D, Coccoli P, Rocco A et al. Gut–liver axis: the impact of gut microbiota on non alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2012; 22: 471–76.
8. Day CP. Genetic and environmental susceptibility to non-alcoholic fatty liver disease. Dig Dis 2010; 28 (1): 55–60.
9. Chalasani N, Younossi Z, Lavine JE et al. 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 2012; 55 (6): 18–23.
10. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 51–62.
11. Бакулин И.Г., Сандлер Ю.Г., Кейян В.А., Ротин Д.Л. Новый неинвазивный метод оценки стеатоза при хронических заболеваниях печени. Терапевт. арх. 2016; 88 (2): 49–57. / Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
12. Poynard T, Muntenau M, Morra R et al. Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update. Gastroenterol Clin Biol 2008; 32 (6; Suppl. 1).
13. Stasi C, Milani S. Non-invasive assessment of liver fibrosis: Between prediction/prevention of outcomes and cost-effectiveness. World J Gastroenterol 2016; 22: 4.
14. Poynard T, Ratziu V, Naveau S et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp Hepatol 2005; 4: None.
15. Jacqueminet S, Lebray P, Morra R et al. Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol 2008; 6: 7.
16. Бакулин И.Г., Сандлер Ю.Г., Винницкая Е.В. и др. Сахарный диабет и неалкогольная жировая болезнь печени – грани сопряженности. Терапевт. арх. 2017; 89 (2): 59–65. 10.17116/terarkh201789259-65 / Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Sakharnyi diabet i nealkogol'naia zhirovaia bolezn' pecheni – grani sopriazhennosti. Terapevt. arkh. 2017; 89 (2): 59–65. 10.17116/terarkh201789259-65 [in Russian]
17. Клинические рекомендации EASL–EASD–EASO по диагностике и лечению неалкогольной жировой болезни печени. Journal of Hepatology 2016; 64: 1388–402. / Klinicheskie rekomendatsii EASL–EASD–EASO po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni. Journal of Hepatology 2016; 64: 1388–402. [in Russian]
18. Van Wagner LB, Koppe SW, Brunt EM et al. Pentoxifylline for the treatment of non-alcoholic steatohepatitis: a randomized controlled trial. Ann Hepatol 2011; 10: 277–86.
19. LaBrecque DR, Abbas Z, Anania F et al. Review Team. World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
J Clin Gastroenterol 2014; 48: 467–73.
20. Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010; 362: 1675–1685.
21. Lindor KD, Kowdley KV, Heathcote EJ et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial. Hepatology 2004; 39: 770–8.
22. Dufour JF, Oneta CM, Gonvers JJ et al. Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin E in nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2006; 4: 1537–43.
23. Leuschner UF, Lindenthal B, Herrmann G et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebo-controlled trial. Hepatology 2010; 52: 472–9.
24. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al, NASH Clinical Research Network. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385: 956–65.
25. Loomba R, Lutchman G, Kleiner DE et al. Clinical trial: pilot study of metformin for the treatment of non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2009; 29: 172–82.
26. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 2015; 62: 3.
27. WHO. Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection book 2014.
28. Shiha G. Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Hepatol Int 2009; 3: 2.
29. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации по диагностике и лечению неалкогольной жировой болезни печени Российского общества по изучению печени и Российской гастроэнтерологической ассоциации. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2016; 2: 24–42. / Ivashkin V.T., Maevskaia M.V., Pavlov Ch.S. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni Rossiiskogo obshchestva po izucheniiu pecheni i Rossiiskoi gastroenterologicheskoi assotsiatsii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016; 2: 24–42. [in Russian]
2. Бакулин И.Г., Сандлер Ю.Г., Винницкая Е.В. и др. Оценка стеатоза печени с помощью неинвазивного метода: миф или реальность? Доктор.Ру. Гастроэнтерология. 2015; 12: 57–64. / Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Otsenka steatoza pecheni s pomoshch'iu neinvazivnogo metoda: mif ili real'nost'? Doktor.Ru. Gastroenterologiia. 2015; 12: 57–64. [in Russian]
3. Бакулин И.Г., Сандлер Ю.Г., Кейян В.А., Ротин Д.Л. Новый неинвазивный метод оценки стеатоза при хронических заболеваниях печени. Терапевт. арх. 2016; 88 (2): 49–57. / Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
4. Драпкина О.М., Ивашкин В.Т. Эпидемиологические особенности неалкогольной жировой болезни печени в России. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2014; 4: 32–8. / Drapkina O.M., Ivashkin V.T. Epidemiologicheskie osobennosti nealkogol'noi zhirovoi bolezni pecheni v Rossii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2014; 4: 32–8. [in Russian]
5. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 17–49.
6. Fassio E, Alvarez E, Domínguez N et al. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004; 40 (4): 820–6.
7. Compare D, Coccoli P, Rocco A et al. Gut–liver axis: the impact of gut microbiota on non alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2012; 22: 471–76.
8. Day CP. Genetic and environmental susceptibility to non-alcoholic fatty liver disease. Dig Dis 2010; 28 (1): 55–60.
9. Chalasani N, Younossi Z, Lavine JE et al. 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 2012; 55 (6): 18–23.
10. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 51–62.
11. Бакулин И.Г., Сандлер Ю.Г., Кейян В.А., Ротин Д.Л. Новый неинвазивный метод оценки стеатоза при хронических заболеваниях печени. Терапевт. арх. 2016; 88 (2): 49–57. / Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
12. Poynard T, Muntenau M, Morra R et al. Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update. Gastroenterol Clin Biol 2008; 32 (6; Suppl. 1).
13. Stasi C, Milani S. Non-invasive assessment of liver fibrosis: Between prediction/prevention of outcomes and cost-effectiveness. World J Gastroenterol 2016; 22: 4.
14. Poynard T, Ratziu V, Naveau S et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp Hepatol 2005; 4: None.
15. Jacqueminet S, Lebray P, Morra R et al. Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol 2008; 6: 7.
16. Бакулин И.Г., Сандлер Ю.Г., Винницкая Е.В. и др. Сахарный диабет и неалкогольная жировая болезнь печени – грани сопряженности. Терапевт. арх. 2017; 89 (2): 59–65. 10.17116/terarkh201789259-65 / Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Sakharnyi diabet i nealkogol'naia zhirovaia bolezn' pecheni – grani sopriazhennosti. Terapevt. arkh. 2017; 89 (2): 59–65. 10.17116/terarkh201789259-65 [in Russian]
17. Клинические рекомендации EASL–EASD–EASO по диагностике и лечению неалкогольной жировой болезни печени. Journal of Hepatology 2016; 64: 1388–402. / Klinicheskie rekomendatsii EASL–EASD–EASO po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni. Journal of Hepatology 2016; 64: 1388–402. [in Russian]
18. Van Wagner LB, Koppe SW, Brunt EM et al. Pentoxifylline for the treatment of non-alcoholic steatohepatitis: a randomized controlled trial. Ann Hepatol 2011; 10: 277–86.
19. LaBrecque DR, Abbas Z, Anania F et al. Review Team. World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
J Clin Gastroenterol 2014; 48: 467–73.
20. Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010; 362: 1675–1685.
21. Lindor KD, Kowdley KV, Heathcote EJ et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial. Hepatology 2004; 39: 770–8.
22. Dufour JF, Oneta CM, Gonvers JJ et al. Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin E in nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2006; 4: 1537–43.
23. Leuschner UF, Lindenthal B, Herrmann G et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebo-controlled trial. Hepatology 2010; 52: 472–9.
24. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al, NASH Clinical Research Network. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385: 956–65.
25. Loomba R, Lutchman G, Kleiner DE et al. Clinical trial: pilot study of metformin for the treatment of non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2009; 29: 172–82.
26. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 2015; 62: 3.
27. WHO. Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection book 2014.
28. Shiha G. Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Hepatol Int 2009; 3: 2.
29. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации по диагностике и лечению неалкогольной жировой болезни печени Российского общества по изучению печени и Российской гастроэнтерологической ассоциации. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2016; 2: 24–42. / Ivashkin V.T., Maevskaia M.V., Pavlov Ch.S. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni Rossiiskogo obshchestva po izucheniiu pecheni i Rossiiskoi gastroenterologicheskoi assotsiatsii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016; 2: 24–42. [in Russian]
________________________________________________
1. Smith BW, Adams LA. Non-alcoholic fatty liver disease. Crit Rev Clin Lab Sci 2011; 8: 97–113.
2. Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Otsenka steatoza pecheni s pomoshch'iu neinvazivnogo metoda: mif ili real'nost'? Doktor.Ru. Gastroenterologiia. 2015; 12: 57–64. [in Russian]
3. Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
4. Drapkina O.M., Ivashkin V.T. Epidemiologicheskie osobennosti nealkogol'noi zhirovoi bolezni pecheni v Rossii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2014; 4: 32–8. [in Russian]
5. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 17–49.
6. Fassio E, Alvarez E, Domínguez N et al. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004; 40 (4): 820–6.
7. Compare D, Coccoli P, Rocco A et al. Gut–liver axis: the impact of gut microbiota on non alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2012; 22: 471–76.
8. Day CP. Genetic and environmental susceptibility to non-alcoholic fatty liver disease. Dig Dis 2010; 28 (1): 55–60.
9. Chalasani N, Younossi Z, Lavine JE et al. 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 2012; 55 (6): 18–23.
10. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 51–62.
11. Bakulin I.G., Sandler Iu.G., Keiian V.A., Rotin D.L. Novyi neinvazivnyi metod otsenki steatoza pri khronicheskikh zabolevaniiakh pecheni. Terapevt. arkh. 2016; 88 (2): 49–57. [in Russian]
12. Poynard T, Muntenau M, Morra R et al. Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update. Gastroenterol Clin Biol 2008; 32 (6; Suppl. 1).
13. Stasi C, Milani S. Non-invasive assessment of liver fibrosis: Between prediction/prevention of outcomes and cost-effectiveness. World J Gastroenterol 2016; 22: 4.
14. Poynard T, Ratziu V, Naveau S et al. The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis. Comp Hepatol 2005; 4: None.
15. Jacqueminet S, Lebray P, Morra R et al. Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol 2008; 6: 7.
16. Bakulin I.G., Sandler Iu.G., Vinnitskaia E.V. i dr. Sakharnyi diabet i nealkogol'naia zhirovaia bolezn' pecheni – grani sopriazhennosti. Terapevt. arkh. 2017; 89 (2): 59–65. 10.17116/terarkh201789259-65 [in Russian]
17. Klinicheskie rekomendatsii EASL–EASD–EASO po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni. Journal of Hepatology 2016; 64: 1388–402. [in Russian]
18. Van Wagner LB, Koppe SW, Brunt EM et al. Pentoxifylline for the treatment of non-alcoholic steatohepatitis: a randomized controlled trial. Ann Hepatol 2011; 10: 277–86.
19. LaBrecque DR, Abbas Z, Anania F et al. Review Team. World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
J Clin Gastroenterol 2014; 48: 467–73.
20. Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010; 362: 1675–1685.
21. Lindor KD, Kowdley KV, Heathcote EJ et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial. Hepatology 2004; 39: 770–8.
22. Dufour JF, Oneta CM, Gonvers JJ et al. Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin E in nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2006; 4: 1537–43.
23. Leuschner UF, Lindenthal B, Herrmann G et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebo-controlled trial. Hepatology 2010; 52: 472–9.
24. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al, NASH Clinical Research Network. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385: 956–65.
25. Loomba R, Lutchman G, Kleiner DE et al. Clinical trial: pilot study of metformin for the treatment of non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2009; 29: 172–82.
26. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 2015; 62: 3.
27. WHO. Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection book 2014.
28. Shiha G. Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Hepatol Int 2009; 3: 2.
29. Ivashkin V.T., Maevskaia M.V., Pavlov Ch.S. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni Rossiiskogo obshchestva po izucheniiu pecheni i Rossiiskoi gastroenterologicheskoi assotsiatsii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016; 2: 24–42. [in Russian]
Авторы
А.В.Полухина, Е.В.Винницкая, Т.Ю.Хайменова, Ю.Г.Сандлер
ГБУЗ «Московский клинический научно-практический центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*lady-stasie@yandex.ru
ГБУЗ «Московский клинический научно-практический центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*lady-stasie@yandex.ru
________________________________________________
A.V.Polukhina, E.V.Vinnitskaya, T.Yu.Haimenova, Yu.G.Sandler
A.S.Loginov Moscow Clinical Scientific Practical Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86
*lady-stasie@yandex.ru
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