Оценка эффективности ультразвуковой сдвиговой эластометрии и стеатометрии печени
Оценка эффективности ультразвуковой сдвиговой эластометрии и стеатометрии печени
Тарасова О.И., Кухарева Е.И., Красницкая С.К. и др. Оценка эффективности ультразвуковой сдвиговой эластометрии и стеатометрии печени. Терапевтический архив. 2020; 92 (4): 17–22. DOI: 10.26442/00403660.2020.04.000497
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Аннотация
Выявление фиброза и стеатоза печени на ранних стадиях представляет сложную задачу для клинической практики ввиду отсутствия ранних признаков в рутинной лучевой диагностике.
Цель. Оценить эффективность применения ультразвуковой (УЗ) сдвиговой эластометрии и УЗ-стеатометрии печени при использовании отечественной диагностической УЗ-системы «Ангиодин-Соно/П-Ультра».
Материалы и методы. Обследованы 264 человека – проведены УЗ-эластометрия и УЗ-стеатометрия; 38 пациентам проведены чрескожная пункционная биопсия печени и последующее патогистологическое исследование.
Результаты. Выявлена высокая корреляция оценок фиброза, полученных на аппарате «Ангиодин-Соно/П-Ультра» и на ведущих УЗ-системах со сдвиговой эластометрией. Проведен одномоментный сравнительный анализ показателей упругости с результатами стеатометрии печени.
Заключение. Результаты эластомерии, полученные во всех трех группах, коррелируют с данными, полученными при исследованиях на УЗ-системе «Фиброскан». При работе с УЗ-системой «Ангиодин» впервые появилась возможность провести одномоментный сравнительный анализ показателей упругости с результатами стеатометрии печени. Результаты эластомерии представляются заметно более стабильными и компактными, чем показатели, полученные при исследованиях на УЗ-системе «Фиброскан». Выявлен новый диагностический критерий – феномен независимости показателей фиброза и стеатоза.
Ключевые слова: фиброз печени, стеатоз печени, ультразвуковая эластометрия, ультразвуковая стеатометрия, упругость тканей печени, коэффициент затухания ультразвуковых волн в тканях печени.
Aim. To evaluate the efficacy of ultrasound shear elastography and ultrasound steatometry of the liver with the use of domestic ultrasonic diagnostic system Angiodin-Sono/N-Ultra.
Materials and methods. 264 people held ultrasound elastography and ultrasound steatometry. 38 patients underwent percutaneous puncture liver biopsy and subsequent pathophysiological examination.
Results. High correlation of fibrosis obtained at the Angiodin-Sono/N-Ultra and the leading ultrasonic systems with shear elastography was revealed. Cross-sectional comparative analysis of elasticity with the results of liver steatometry was conducted.
Conclusions. Results obtained in all groups correlate with the data obtained in studies on Fibroscan. When working with system Angiodin we got a simultaneous comparative analysis of elasticity with the results of liver steatosis. Results appear to be much more stable and compact than those obtained in studies on the Fibroscan. A new diagnostic criterion was revealed – the phenomenon of independence of fibrosis and steatosis indices.
Keywords: liver fibrosis, hepatic steatosis, ultrasound elastography, steatometry, elasticity of liver tissue, attenuation coefficient of ultrasonic waves in the tissues of the liver.
Цель. Оценить эффективность применения ультразвуковой (УЗ) сдвиговой эластометрии и УЗ-стеатометрии печени при использовании отечественной диагностической УЗ-системы «Ангиодин-Соно/П-Ультра».
Материалы и методы. Обследованы 264 человека – проведены УЗ-эластометрия и УЗ-стеатометрия; 38 пациентам проведены чрескожная пункционная биопсия печени и последующее патогистологическое исследование.
Результаты. Выявлена высокая корреляция оценок фиброза, полученных на аппарате «Ангиодин-Соно/П-Ультра» и на ведущих УЗ-системах со сдвиговой эластометрией. Проведен одномоментный сравнительный анализ показателей упругости с результатами стеатометрии печени.
Заключение. Результаты эластомерии, полученные во всех трех группах, коррелируют с данными, полученными при исследованиях на УЗ-системе «Фиброскан». При работе с УЗ-системой «Ангиодин» впервые появилась возможность провести одномоментный сравнительный анализ показателей упругости с результатами стеатометрии печени. Результаты эластомерии представляются заметно более стабильными и компактными, чем показатели, полученные при исследованиях на УЗ-системе «Фиброскан». Выявлен новый диагностический критерий – феномен независимости показателей фиброза и стеатоза.
Ключевые слова: фиброз печени, стеатоз печени, ультразвуковая эластометрия, ультразвуковая стеатометрия, упругость тканей печени, коэффициент затухания ультразвуковых волн в тканях печени.
________________________________________________
Aim. To evaluate the efficacy of ultrasound shear elastography and ultrasound steatometry of the liver with the use of domestic ultrasonic diagnostic system Angiodin-Sono/N-Ultra.
Materials and methods. 264 people held ultrasound elastography and ultrasound steatometry. 38 patients underwent percutaneous puncture liver biopsy and subsequent pathophysiological examination.
Results. High correlation of fibrosis obtained at the Angiodin-Sono/N-Ultra and the leading ultrasonic systems with shear elastography was revealed. Cross-sectional comparative analysis of elasticity with the results of liver steatometry was conducted.
Conclusions. Results obtained in all groups correlate with the data obtained in studies on Fibroscan. When working with system Angiodin we got a simultaneous comparative analysis of elasticity with the results of liver steatosis. Results appear to be much more stable and compact than those obtained in studies on the Fibroscan. A new diagnostic criterion was revealed – the phenomenon of independence of fibrosis and steatosis indices.
Keywords: liver fibrosis, hepatic steatosis, ultrasound elastography, steatometry, elasticity of liver tissue, attenuation coefficient of ultrasonic waves in the tissues of the liver.
Список литературы
1. Ivashkin VT, Maevskaya MV, Pavlov ChS, Tihonov IN. Klinicheskie rekomendacii po diagnostike i lecheniyu nealkogol'noj zhirovoj bolezni pecheni Rossijskogo obshchestva po izucheniyu pecheni i Rossijskoj gastroenterologicheskoj associacii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016;2:24-42 (In Russ.) doi: 10.22416/1382-4376-2016-26-2-24-42
2. Celikovskij AV, Pritulina YuG, Astapchenko DS, et al. Vliyanie steatoza pecheni na effektivnost' kombinirovannoj protivovirusnoj terapii hronicheskogo gepatita S. Sovremennye problemy nauki i obrazovaniya. 2012;6:186 (In Russ.)
3. Chan H, Wong G, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16(1):36-44. doi: 10.1111/j.1365-2893.2008.01037.x
4. Castera L, Vilgrain V, Anguo P. Nonivasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10:666-75. doi: 10.1038/ nrgastro.2013.175 PMID: 24061203
5. Bakulin IG, Sandler YuG, Kejyan VA, Rotin DL. Novyj neinvazivnyj metod ocenki steatoza pri hronicheskih zabolevaniyah pecheni. Therapeutic Archive. 2016;88(2):49-57 (In Russ.) doi: 10.17116/terarkh201688249-57
6. Castera L, Vergniol J, Foucher J et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343-50. doi: 10.1053/j.gastro.2004.11.018
7. Bedossa P. Current histological classification of NAFLD: strength and limitations. Hepatol Int. 2013;7(2):765-70. doi: 10.1007/s12072-013-9446-z
8. Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shearwave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910-8. doi: 10.1148/radiol.13130128
9. Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsyproven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology. 2018;67:260-72. doi: 10.1002/hep.29179
10. Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454-62. doi: 10.1002/hep.23312
11. Castera L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828-35. doi: 10.1002/hep.23425
12. Sporea I, Jurchiş A, Şirli R, et al. Can Transient Elastography be a reliable method for assessing liver fibrosis in Non Alcoholic Steatohepatitis (NASH)? Med Ultrason. 2013;15(2):106-10. doi: 10.11152/mu. 2013.2066.152.is1aj2
13. Mulabecirovic A, Mjelle AB, Gilja OH, et al. Liver elasticity in healthy individuals by two novel shear-wave elastography systems – Comparison by age, gender, BMI and number of measurements. PloS one. 2018;13(9):art.no.e0203486. doi: 10.1371/journal.pone.0203486
14. Zeng J, Zheng J, Huang Z, et al. Comparison of 2-D Shear Wave Elastography and Transient Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Ultrasound Med Biol. 2017;43:1563-70. doi: 10.1016/j.ultrasmedbio.2017.03.014
15. Wu T, Wang P, Zhang T, et al. Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Dig Dis. 2016;34:640-9. doi: 10.1159/000448825
16. Zhuang Y, Ding H, Zhang Y, et al. Twodimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology. 2017;283:873-82. doi: 10.1148/radiol.2016160131
17. De Lédinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820
18. Kosasih S, Zhi Qin W, Abdul Rani R, et al. Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease. Int J Hepatol. 2018:9252536. doi: 10.1155/2018/9252536
2. Celikovskij AV, Pritulina YuG, Astapchenko DS, et al. Vliyanie steatoza pecheni na effektivnost' kombinirovannoj protivovirusnoj terapii hronicheskogo gepatita S. Sovremennye problemy nauki i obrazovaniya. 2012;6:186 (In Russ.)
3. Chan H, Wong G, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16(1):36-44. doi: 10.1111/j.1365-2893.2008.01037.x
4. Castera L, Vilgrain V, Anguo P. Nonivasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10:666-75. doi: 10.1038/ nrgastro.2013.175 PMID: 24061203
5. Bakulin IG, Sandler YuG, Kejyan VA, Rotin DL. Novyj neinvazivnyj metod ocenki steatoza pri hronicheskih zabolevaniyah pecheni. Therapeutic Archive. 2016;88(2):49-57 (In Russ.) doi: 10.17116/terarkh201688249-57
6. Castera L, Vergniol J, Foucher J et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343-50. doi: 10.1053/j.gastro.2004.11.018
7. Bedossa P. Current histological classification of NAFLD: strength and limitations. Hepatol Int. 2013;7(2):765-70. doi: 10.1007/s12072-013-9446-z
8. Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shearwave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910-8. doi: 10.1148/radiol.13130128
9. Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsyproven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology. 2018;67:260-72. doi: 10.1002/hep.29179
10. Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454-62. doi: 10.1002/hep.23312
11. Castera L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828-35. doi: 10.1002/hep.23425
12. Sporea I, Jurchiş A, Şirli R, et al. Can Transient Elastography be a reliable method for assessing liver fibrosis in Non Alcoholic Steatohepatitis (NASH)? Med Ultrason. 2013;15(2):106-10. doi: 10.11152/mu. 2013.2066.152.is1aj2
13. Mulabecirovic A, Mjelle AB, Gilja OH, et al. Liver elasticity in healthy individuals by two novel shear-wave elastography systems – Comparison by age, gender, BMI and number of measurements. PloS one. 2018;13(9):art.no.e0203486. doi: 10.1371/journal.pone.0203486
14. Zeng J, Zheng J, Huang Z, et al. Comparison of 2-D Shear Wave Elastography and Transient Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Ultrasound Med Biol. 2017;43:1563-70. doi: 10.1016/j.ultrasmedbio.2017.03.014
15. Wu T, Wang P, Zhang T, et al. Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Dig Dis. 2016;34:640-9. doi: 10.1159/000448825
16. Zhuang Y, Ding H, Zhang Y, et al. Twodimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology. 2017;283:873-82. doi: 10.1148/radiol.2016160131
17. De Lédinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820
18. Kosasih S, Zhi Qin W, Abdul Rani R, et al. Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease. Int J Hepatol. 2018:9252536. doi: 10.1155/2018/9252536
2. Celikovskij AV, Pritulina YuG, Astapchenko DS, et al. Vliyanie steatoza pecheni na effektivnost' kombinirovannoj protivovirusnoj terapii hronicheskogo gepatita S. Sovremennye problemy nauki i obrazovaniya. 2012;6:186 (In Russ.)
3. Chan H, Wong G, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16(1):36-44. doi: 10.1111/j.1365-2893.2008.01037.x
4. Castera L, Vilgrain V, Anguo P. Nonivasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10:666-75. doi: 10.1038/ nrgastro.2013.175 PMID: 24061203
5. Bakulin IG, Sandler YuG, Kejyan VA, Rotin DL. Novyj neinvazivnyj metod ocenki steatoza pri hronicheskih zabolevaniyah pecheni. Therapeutic Archive. 2016;88(2):49-57 (In Russ.) doi: 10.17116/terarkh201688249-57
6. Castera L, Vergniol J, Foucher J et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343-50. doi: 10.1053/j.gastro.2004.11.018
7. Bedossa P. Current histological classification of NAFLD: strength and limitations. Hepatol Int. 2013;7(2):765-70. doi: 10.1007/s12072-013-9446-z
8. Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shearwave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910-8. doi: 10.1148/radiol.13130128
9. Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsyproven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology. 2018;67:260-72. doi: 10.1002/hep.29179
10. Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454-62. doi: 10.1002/hep.23312
11. Castera L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828-35. doi: 10.1002/hep.23425
12. Sporea I, Jurchiş A, Şirli R, et al. Can Transient Elastography be a reliable method for assessing liver fibrosis in Non Alcoholic Steatohepatitis (NASH)? Med Ultrason. 2013;15(2):106-10. doi: 10.11152/mu. 2013.2066.152.is1aj2
13. Mulabecirovic A, Mjelle AB, Gilja OH, et al. Liver elasticity in healthy individuals by two novel shear-wave elastography systems – Comparison by age, gender, BMI and number of measurements. PloS one. 2018;13(9):art.no.e0203486. doi: 10.1371/journal.pone.0203486
14. Zeng J, Zheng J, Huang Z, et al. Comparison of 2-D Shear Wave Elastography and Transient Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Ultrasound Med Biol. 2017;43:1563-70. doi: 10.1016/j.ultrasmedbio.2017.03.014
15. Wu T, Wang P, Zhang T, et al. Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Dig Dis. 2016;34:640-9. doi: 10.1159/000448825
16. Zhuang Y, Ding H, Zhang Y, et al. Twodimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology. 2017;283:873-82. doi: 10.1148/radiol.2016160131
17. De Lédinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820
18. Kosasih S, Zhi Qin W, Abdul Rani R, et al. Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease. Int J Hepatol. 2018:9252536. doi: 10.1155/2018/9252536
________________________________________________
2. Celikovskij AV, Pritulina YuG, Astapchenko DS, et al. Vliyanie steatoza pecheni na effektivnost' kombinirovannoj protivovirusnoj terapii hronicheskogo gepatita S. Sovremennye problemy nauki i obrazovaniya. 2012;6:186 (In Russ.)
3. Chan H, Wong G, Choi PC, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16(1):36-44. doi: 10.1111/j.1365-2893.2008.01037.x
4. Castera L, Vilgrain V, Anguo P. Nonivasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10:666-75. doi: 10.1038/ nrgastro.2013.175 PMID: 24061203
5. Bakulin IG, Sandler YuG, Kejyan VA, Rotin DL. Novyj neinvazivnyj metod ocenki steatoza pri hronicheskih zabolevaniyah pecheni. Therapeutic Archive. 2016;88(2):49-57 (In Russ.) doi: 10.17116/terarkh201688249-57
6. Castera L, Vergniol J, Foucher J et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343-50. doi: 10.1053/j.gastro.2004.11.018
7. Bedossa P. Current histological classification of NAFLD: strength and limitations. Hepatol Int. 2013;7(2):765-70. doi: 10.1007/s12072-013-9446-z
8. Leung VY, Shen J, Wong VW, et al. Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shearwave elastography and transient elastography with liver biopsy correlation. Radiology. 2013;269:910-8. doi: 10.1148/radiol.13130128
9. Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsyproven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology. 2018;67:260-72. doi: 10.1002/hep.29179
10. Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454-62. doi: 10.1002/hep.23312
11. Castera L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828-35. doi: 10.1002/hep.23425
12. Sporea I, Jurchiş A, Şirli R, et al. Can Transient Elastography be a reliable method for assessing liver fibrosis in Non Alcoholic Steatohepatitis (NASH)? Med Ultrason. 2013;15(2):106-10. doi: 10.11152/mu. 2013.2066.152.is1aj2
13. Mulabecirovic A, Mjelle AB, Gilja OH, et al. Liver elasticity in healthy individuals by two novel shear-wave elastography systems – Comparison by age, gender, BMI and number of measurements. PloS one. 2018;13(9):art.no.e0203486. doi: 10.1371/journal.pone.0203486
14. Zeng J, Zheng J, Huang Z, et al. Comparison of 2-D Shear Wave Elastography and Transient Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Ultrasound Med Biol. 2017;43:1563-70. doi: 10.1016/j.ultrasmedbio.2017.03.014
15. Wu T, Wang P, Zhang T, et al. Comparison of Two-Dimensional Shear Wave Elastography and Real-Time Tissue Elastography for Assessing Liver Fibrosis in Chronic Hepatitis B. Dig Dis. 2016;34:640-9. doi: 10.1159/000448825
16. Zhuang Y, Ding H, Zhang Y, et al. Twodimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology. 2017;283:873-82. doi: 10.1148/radiol.2016160131
17. De Lédinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820
18. Kosasih S, Zhi Qin W, Abdul Rani R, et al. Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease. Int J Hepatol. 2018:9252536. doi: 10.1155/2018/9252536
Авторы
О.И. Тарасова, Е.И. Кухарева, С.К. Красницкая, Н.В. Мазурчик, М.Я. Нгамени, Н.А. Малинина, Б.И. Зыкин, П.П. Огурцов
ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия
Рeoples’ Friendship University of Russia, Moscow, Russia
ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия
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Рeoples’ Friendship University of Russia, Moscow, Russia
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