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Внедрение в клиническую практику алгоритма диагностики стеатоза печени у пациентов с вирусной пневмонией - Журнал Терапевтический архив №8 Вопросы лечения 2025
Внедрение в клиническую практику алгоритма диагностики стеатоза печени у пациентов с вирусной пневмонией
Туранкова Т.А., Бражников А.Ю., Мороз Н.Г., Мудрова А.В., Варганова Д.Л., Павлов Ч.С. Внедрение в клиническую практику алгоритма диагностики стеатоза печени у пациентов с вирусной пневмонией. Терапевтический архив. 2025;97(8):704–710. DOI: 10.26442/00403660.2025.08.203365
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Цель. Изучить возможности и значение выявления стеатоза печени во время проведения компьютерной томографии (КТ) органов грудной клетки пациентам с вирусной пневмонией.
Материалы и методы. В когортное проспективное исследование включены 100 пациентов в возрасте старше 18 лет, госпитализированных с установленным диагнозом вирусной пневмонии. Для выявления значительного стеатоза печени (более 33%) по КТ использовалось несколько подходов: плотность печени – менее 40 HU, ослабление плотности печени по крайней мере на 10 HU меньше, чем у селезенки, отношение ослабления плотности печени к селезенке – менее 0,9.
Результаты. По данным КТ выделены 25 пациентов с имеющимся стеатозом печени и другими критериями метаболически ассоциированной жировой болезни печени и 74 пациента контрольной группы без признаков значительного стеатоза, 1 пациент исключен в связи со злоупотреблением алкоголем. Выявлена достоверная разница при изучении плотности печени (31,68±10,67 и 54,44±5,95; р<0,001), отношения уменьшения плотности печени к плотности селезенки (0,66±0,22 и 1,16±0,13; р<0,001), а также уменьшение плотности печени по отношению к селезенке (16,3±10,38 и -7,26±6,1; р<0,001). В группе стеатоза отмечено более тяжелое течение пневмонии (р=0,041). Частота ухудшения состояния по данным КТ была сопоставима в обеих группах: 19 (76,0%) и 45 (60,8%); р=0,169, хотя его тяжесть была выше в группе со стеатозом (р=0,012). Пациентам из группы стеатоза значительно чаще назначали биологическую (88,0 и 39,19%; р<0.001) и антибактериальную терапию (68,0 и 40,54%; p=0,017).
Заключение. Внедрение оценки степени стеатоза печени по данным КТ одновременно с изучением основного заболевания может стать важным диагностическим этапом, определяющим прогноз течения заболевания, а также инструментом стратификации риска у пациентов с метаболически ассоциированной жировой болезнью печени.
Ключевые слова: стеатоз печени, метаболически ассоциированная жировая болезнь печени, компьютерная томография, индекс стеатоза печени
Materials and methods. A prospective cohort study included 100 patients over the age of 18 who were hospitalized with an established diagnosis of viral pneumonia. To CT detection significant liver steatosis (more than 33%), several approaches were used: liver density less than 40 HU; decrease in liver density by at least 10 HU less than the spleen; the ratio of decrease in liver density to the spleen is less than 0.9.
Results. According to CT data 2 groups were identified: 25 patients with existing liver steatosis and metabolically associated fatty liver disease, and 74 patients of the control group without signs of significant steatosis, оne patient was excluded due to alcohol abuse. There was a significant difference in the study of liver density (31.68±10.67 and 54.44±5.95; p<0.001), the ratio of decrease in liver density to spleen density (0.66±0.22 and 1.16±0.13; p<0.001), as well as a decrease in liver density relative to the spleen (16.30±10.38 and -7.26±6.10; p<0.001). In the steatosis group, a more severe course of pneumonia was noted (p=0.041). The incidence of deterioration according to CT was comparable in both groups: 19 (76%) and 45 (60.8%); p=0.169, although its severity was higher in the group with steatosis (p=0.012). Patients from the steatosis group were significantly more often prescribed biological (88.0 and 39.19%; p<0.001) and antibacterial therapy (68.0 and 40.54%; p=0.017).
Conclusion. The use of assessment of liver steatosis according to CT data simultaneously with the study of the underlying disease can become an important diagnostic step determining the prognosis of the course of the disease, as well as a tool for risk stratification in patients with metabolically associated fatty liver disease.
Keywords: liver steatosis, metabolically associated fatty liver disease, computed tomography, Hepatic Steatosis Index
Материалы и методы. В когортное проспективное исследование включены 100 пациентов в возрасте старше 18 лет, госпитализированных с установленным диагнозом вирусной пневмонии. Для выявления значительного стеатоза печени (более 33%) по КТ использовалось несколько подходов: плотность печени – менее 40 HU, ослабление плотности печени по крайней мере на 10 HU меньше, чем у селезенки, отношение ослабления плотности печени к селезенке – менее 0,9.
Результаты. По данным КТ выделены 25 пациентов с имеющимся стеатозом печени и другими критериями метаболически ассоциированной жировой болезни печени и 74 пациента контрольной группы без признаков значительного стеатоза, 1 пациент исключен в связи со злоупотреблением алкоголем. Выявлена достоверная разница при изучении плотности печени (31,68±10,67 и 54,44±5,95; р<0,001), отношения уменьшения плотности печени к плотности селезенки (0,66±0,22 и 1,16±0,13; р<0,001), а также уменьшение плотности печени по отношению к селезенке (16,3±10,38 и -7,26±6,1; р<0,001). В группе стеатоза отмечено более тяжелое течение пневмонии (р=0,041). Частота ухудшения состояния по данным КТ была сопоставима в обеих группах: 19 (76,0%) и 45 (60,8%); р=0,169, хотя его тяжесть была выше в группе со стеатозом (р=0,012). Пациентам из группы стеатоза значительно чаще назначали биологическую (88,0 и 39,19%; р<0.001) и антибактериальную терапию (68,0 и 40,54%; p=0,017).
Заключение. Внедрение оценки степени стеатоза печени по данным КТ одновременно с изучением основного заболевания может стать важным диагностическим этапом, определяющим прогноз течения заболевания, а также инструментом стратификации риска у пациентов с метаболически ассоциированной жировой болезнью печени.
Ключевые слова: стеатоз печени, метаболически ассоциированная жировая болезнь печени, компьютерная томография, индекс стеатоза печени
________________________________________________
Materials and methods. A prospective cohort study included 100 patients over the age of 18 who were hospitalized with an established diagnosis of viral pneumonia. To CT detection significant liver steatosis (more than 33%), several approaches were used: liver density less than 40 HU; decrease in liver density by at least 10 HU less than the spleen; the ratio of decrease in liver density to the spleen is less than 0.9.
Results. According to CT data 2 groups were identified: 25 patients with existing liver steatosis and metabolically associated fatty liver disease, and 74 patients of the control group without signs of significant steatosis, оne patient was excluded due to alcohol abuse. There was a significant difference in the study of liver density (31.68±10.67 and 54.44±5.95; p<0.001), the ratio of decrease in liver density to spleen density (0.66±0.22 and 1.16±0.13; p<0.001), as well as a decrease in liver density relative to the spleen (16.30±10.38 and -7.26±6.10; p<0.001). In the steatosis group, a more severe course of pneumonia was noted (p=0.041). The incidence of deterioration according to CT was comparable in both groups: 19 (76%) and 45 (60.8%); p=0.169, although its severity was higher in the group with steatosis (p=0.012). Patients from the steatosis group were significantly more often prescribed biological (88.0 and 39.19%; p<0.001) and antibacterial therapy (68.0 and 40.54%; p=0.017).
Conclusion. The use of assessment of liver steatosis according to CT data simultaneously with the study of the underlying disease can become an important diagnostic step determining the prognosis of the course of the disease, as well as a tool for risk stratification in patients with metabolically associated fatty liver disease.
Keywords: liver steatosis, metabolically associated fatty liver disease, computed tomography, Hepatic Steatosis Index
Полный текст
Список литературы
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10. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
11. Farrell GC, McCullough AJ, Day CP. (Eds.) Non-alcoholic fatty liver disease: A practical guide. New York: Wiley Blackwell, 2013.
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15. Cao YT, Xiang LL, Qi F, et al. Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. EClinicalMedicine. 2022;51:101547. DOI:10.1016/j.eclinm.2022.101547
16. Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: A meta-analysis. Eur Radiol. 2019;29(7):3564-73. DOI:10.1007/s00330-019-06072-4
17. Wang XM, Zhang XJ, Ma L. Diagnostic performance of magnetic resonance technology in detecting steatosis or fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Medicine (Baltimore). 2018;97(21):e10605. DOI:10.1097/MD.0000000000010605
18. Jawahar A, Gonzalez B, Balasubramanian N, et al. Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol. 2020;32(2):216-21. DOI:10.1097/MEG.0000000000001502
19. Byun J, Lee SS, Sung YS, et al. CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: Development and validation of diagnostic cut-off values in a large cohort with pathological reference standard. Eur Radiol. 2019;29(8):4427-35. DOI:10.1007/s00330-018-5905-1
20. Park HJ, Kim KW, Kwon HJ, et al. CT-based visual grading system for assessment of hepatic steatosis: Diagnostic performance and interobserver agreement. Hepatol Int. 2022;16(5):1075-84. DOI:10.1007/s12072-022-10373-0
21. Guo Z, Blake GM, Li K, et al. Liver fat content measurement with quantitative CT validated against MRI proton density fat fraction: A prospective study of 400 healthy volunteers. Radiology. 2020;294(1):89-97. DOI:10.1148/radiol.2019190467
22. Hu N, Yan G, Tang M, et al. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp. 2023;7(1):72. DOI:10.1186/s41747-023-00387-0
23. Engelke K. Quantitative computed tomography – Current status and new developments. J Clin Densitom. 2017;20(3):309-21. DOI:10.1016/j.jocd.2017.06.017
24. Starekova J, Hernando D, Pickhardt PJ, Reeder SB. Quantification of liver fat content with CT and MRI: State of the art. Radiology. 2021;301(2):250-62. DOI:10.1148/radiol.2021204288
25. Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-associated liver disease. Am J Gastroenterol. 2024;119(1):30-54. DOI:10.14309/ajg.0000000000002572
26. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42(7):503-8. DOI:10.1016/j.dld.2009.08.002
27. Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 2012;199(1):44-7. DOI:10.2214/AJR.11.7838
28. Lebre MA, Vacavant A, Grand-Brochier M, et al. Automatic segmentation methods for liver and hepatic vessels from CT and MRI volumes, applied to the Couinaud scheme. Comput Biol Med. 2019;110:42-51. DOI:10.1016/j.compbiomed.2019.04.014
29. Wong VW, Ekstedt M, Wong GL, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023;79(3):842-52. DOI:10.1016/j.jhep.2023.04.036
30. DiStefano JK, Gerhard GS. NAFLD in normal weight individuals. Diabetol Metab Syndr. 2022;14(1):45. DOI:10.1186/s13098-022-00814-z
31. Tan D, Chan KE, Wong ZY, et al. Global epidemiology of cirrhosis: Changing etiological basis and comparable burden of nonalcoholic steatohepatitis between males and females. Dig Dis. 2023;41(6):900-12. DOI:10.1159/000533946
32. Chung J, Park HS, Kim YJ, et al. Association of Hepatic Steatosis Index with nonalcoholic fatty liver disease diagnosed by non-enhanced CT in a screening population. Diagnostics (Basel). 2021;11(12):2168. DOI:10.3390/diagnostics11122168
2. Amini-Salehi E, Letafatkar N, Norouzi N, et al. Global prevalence of nonalcoholic fatty liver disease: an updated meta-analysis on 78 million population over 38 countries. Arch Med Res. 2024;55(6):103043. DOI:10.1016/j.arcmed.2024.103043
3. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-86. DOI:10.1097/HEP.0000000000000520
4. Pavlov ChS, Teplyuk DA, Lazebnik LB, et al. The clinician's view on the advantages and contradictions of the new nomenclature of steatotic liver disease: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(4):429-35 (in Russian). DOI:10.26442/00403660.2024.04.202747
5. Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
6. Drapkina OM, Martynov AI, Arutyunov GP, et al. Resolution of the Expert Forum "New therapeutic horizons of NAFLD". Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(2):186-93 (in Russian). DOI:10.26442/00403660.2024.02.202648
7. Bae JS, Lee DH, Suh KS, et al. Noninvasive assessment of hepatic steatosis using a pathologic reference standard: comparison of CT, MRI, and US-based techniques. Ultrasonography. 2022;41(2):344-54. DOI:10.14366/usg.21150
8. Kazi IN, Kuo L, Tsai E. Noninvasive methods for assessing liver fibrosis and steatosis. Gastroenterol Hepatol (N Y). 2024;20(1):21-9. PMID:38405045
9. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-62. DOI:10.1016/j.eprac.2022.03.010
10. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
11. Farrell GC, McCullough AJ, Day CP. (Eds.) Non-alcoholic fatty liver disease: A practical guide. New York: Wiley Blackwell, 2013.
12. Chitturi S, Wong VW, Chan WK, et al. The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease Guidelines 2017 – Part 2: Management and special groups. J Gastroenterol Hepatol. 2018;33(1):86-98. DOI:10.1111/jgh.13856
13. Brunt EM. Nonalcoholic fatty liver disease: Pros and cons of histologic systems of evaluation. Int J Mol Sci. 2016;17(1):97. DOI:10.3390/ijms17010097
14. Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound methods for the assessment of liver steatosis: A critical appraisal. Diagnostics (Basel). 2022;12(10):2287. DOI:10.3390/diagnostics12102287
15. Cao YT, Xiang LL, Qi F, et al. Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. EClinicalMedicine. 2022;51:101547. DOI:10.1016/j.eclinm.2022.101547
16. Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: A meta-analysis. Eur Radiol. 2019;29(7):3564-73. DOI:10.1007/s00330-019-06072-4
17. Wang XM, Zhang XJ, Ma L. Diagnostic performance of magnetic resonance technology in detecting steatosis or fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Medicine (Baltimore). 2018;97(21):e10605. DOI:10.1097/MD.0000000000010605
18. Jawahar A, Gonzalez B, Balasubramanian N, et al. Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol. 2020;32(2):216-21. DOI:10.1097/MEG.0000000000001502
19. Byun J, Lee SS, Sung YS, et al. CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: Development and validation of diagnostic cut-off values in a large cohort with pathological reference standard. Eur Radiol. 2019;29(8):4427-35. DOI:10.1007/s00330-018-5905-1
20. Park HJ, Kim KW, Kwon HJ, et al. CT-based visual grading system for assessment of hepatic steatosis: Diagnostic performance and interobserver agreement. Hepatol Int. 2022;16(5):1075-84. DOI:10.1007/s12072-022-10373-0
21. Guo Z, Blake GM, Li K, et al. Liver fat content measurement with quantitative CT validated against MRI proton density fat fraction: A prospective study of 400 healthy volunteers. Radiology. 2020;294(1):89-97. DOI:10.1148/radiol.2019190467
22. Hu N, Yan G, Tang M, et al. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp. 2023;7(1):72. DOI:10.1186/s41747-023-00387-0
23. Engelke K. Quantitative computed tomography – Current status and new developments. J Clin Densitom. 2017;20(3):309-21. DOI:10.1016/j.jocd.2017.06.017
24. Starekova J, Hernando D, Pickhardt PJ, Reeder SB. Quantification of liver fat content with CT and MRI: State of the art. Radiology. 2021;301(2):250-62. DOI:10.1148/radiol.2021204288
25. Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-associated liver disease. Am J Gastroenterol. 2024;119(1):30-54. DOI:10.14309/ajg.0000000000002572
26. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42(7):503-8. DOI:10.1016/j.dld.2009.08.002
27. Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 2012;199(1):44-7. DOI:10.2214/AJR.11.7838
28. Lebre MA, Vacavant A, Grand-Brochier M, et al. Automatic segmentation methods for liver and hepatic vessels from CT and MRI volumes, applied to the Couinaud scheme. Comput Biol Med. 2019;110:42-51. DOI:10.1016/j.compbiomed.2019.04.014
29. Wong VW, Ekstedt M, Wong GL, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023;79(3):842-52. DOI:10.1016/j.jhep.2023.04.036
30. DiStefano JK, Gerhard GS. NAFLD in normal weight individuals. Diabetol Metab Syndr. 2022;14(1):45. DOI:10.1186/s13098-022-00814-z
31. Tan D, Chan KE, Wong ZY, et al. Global epidemiology of cirrhosis: Changing etiological basis and comparable burden of nonalcoholic steatohepatitis between males and females. Dig Dis. 2023;41(6):900-12. DOI:10.1159/000533946
32. Chung J, Park HS, Kim YJ, et al. Association of Hepatic Steatosis Index with nonalcoholic fatty liver disease diagnosed by non-enhanced CT in a screening population. Diagnostics (Basel). 2021;11(12):2168. DOI:10.3390/diagnostics11122168
2. Amini-Salehi E, Letafatkar N, Norouzi N, et al. Global prevalence of nonalcoholic fatty liver disease: an updated meta-analysis on 78 million population over 38 countries. Arch Med Res. 2024;55(6):103043. DOI:10.1016/j.arcmed.2024.103043
3. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-86. DOI:10.1097/HEP.0000000000000520
4. Павлов Ч.С., Теплюк Д.А., Лазебник Л.Б., и др. Взгляд клинициста на преимущества и противоречия новой номенклатуры стеатозной болезни печени. Терапевтический архив. 2024;96(4):429-35 [Pavlov ChS, Teplyuk DA, Lazebnik LB, et al. The clinician's view on the advantages and contradictions of the new nomenclature of steatotic liver disease: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(4):429-35 (in Russian)]. DOI:10.26442/00403660.2024.04.202747
5. Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
6. Драпкина О.М., Мартынов А.И., Арутюнов Г.П., и др. Резолюция Форума экспертов «Новые терапевтические горизонты НАЖБП». Терапевтический архив. 2024;96(2):186-93 [Drapkina OM, Martynov AI, Arutyunov GP, et al. Resolution of the Expert Forum "New therapeutic horizons of NAFLD". Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(2):186-93 (in Russian)]. DOI:10.26442/00403660.2024.02.202648
7. Bae JS, Lee DH, Suh KS, et al. Noninvasive assessment of hepatic steatosis using a pathologic reference standard: comparison of CT, MRI, and US-based techniques. Ultrasonography. 2022;41(2):344-54. DOI:10.14366/usg.21150
8. Kazi IN, Kuo L, Tsai E. Noninvasive methods for assessing liver fibrosis and steatosis. Gastroenterol Hepatol (N Y). 2024;20(1):21-9. PMID:38405045
9. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-62. DOI:10.1016/j.eprac.2022.03.010
10. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
11. Farrell GC, McCullough AJ, Day CP. (Eds.) Non-alcoholic fatty liver disease: A practical guide. New York: Wiley Blackwell, 2013.
12. Chitturi S, Wong VW, Chan WK, et al. The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease Guidelines 2017 – Part 2: Management and special groups. J Gastroenterol Hepatol. 2018;33(1):86-98. DOI:10.1111/jgh.13856
13. Brunt EM. Nonalcoholic fatty liver disease: Pros and cons of histologic systems of evaluation. Int J Mol Sci. 2016;17(1):97. DOI:10.3390/ijms17010097
14. Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound methods for the assessment of liver steatosis: A critical appraisal. Diagnostics (Basel). 2022;12(10):2287. DOI:10.3390/diagnostics12102287
15. Cao YT, Xiang LL, Qi F, et al. Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. EClinicalMedicine. 2022;51:101547. DOI:10.1016/j.eclinm.2022.101547
16. Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: A meta-analysis. Eur Radiol. 2019;29(7):3564-73. DOI:10.1007/s00330-019-06072-4
17. Wang XM, Zhang XJ, Ma L. Diagnostic performance of magnetic resonance technology in detecting steatosis or fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Medicine (Baltimore). 2018;97(21):e10605. DOI:10.1097/MD.0000000000010605
18. Jawahar A, Gonzalez B, Balasubramanian N, et al. Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol. 2020;32(2):216-21. DOI:10.1097/MEG.0000000000001502
19. Byun J, Lee SS, Sung YS, et al. CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: Development and validation of diagnostic cut-off values in a large cohort with pathological reference standard. Eur Radiol. 2019;29(8):4427-35. DOI:10.1007/s00330-018-5905-1
20. Park HJ, Kim KW, Kwon HJ, et al. CT-based visual grading system for assessment of hepatic steatosis: Diagnostic performance and interobserver agreement. Hepatol Int. 2022;16(5):1075-84. DOI:10.1007/s12072-022-10373-0
21. Guo Z, Blake GM, Li K, et al. Liver fat content measurement with quantitative CT validated against MRI proton density fat fraction: A prospective study of 400 healthy volunteers. Radiology. 2020;294(1):89-97. DOI:10.1148/radiol.2019190467
22. Hu N, Yan G, Tang M, et al. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp. 2023;7(1):72. DOI:10.1186/s41747-023-00387-0
23. Engelke K. Quantitative computed tomography – Current status and new developments. J Clin Densitom. 2017;20(3):309-21. DOI:10.1016/j.jocd.2017.06.017
24. Starekova J, Hernando D, Pickhardt PJ, Reeder SB. Quantification of liver fat content with CT and MRI: State of the art. Radiology. 2021;301(2):250-62. DOI:10.1148/radiol.2021204288
25. Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-associated liver disease. Am J Gastroenterol. 2024;119(1):30-54. DOI:10.14309/ajg.0000000000002572
26. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42(7):503-8. DOI:10.1016/j.dld.2009.08.002
27. Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 2012;199(1):44-7. DOI:10.2214/AJR.11.7838
28. Lebre MA, Vacavant A, Grand-Brochier M, et al. Automatic segmentation methods for liver and hepatic vessels from CT and MRI volumes, applied to the Couinaud scheme. Comput Biol Med. 2019;110:42-51. DOI:10.1016/j.compbiomed.2019.04.014
29. Wong VW, Ekstedt M, Wong GL, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023;79(3):842-52. DOI:10.1016/j.jhep.2023.04.036
30. DiStefano JK, Gerhard GS. NAFLD in normal weight individuals. Diabetol Metab Syndr. 2022;14(1):45. DOI:10.1186/s13098-022-00814-z
31. Tan D, Chan KE, Wong ZY, et al. Global epidemiology of cirrhosis: Changing etiological basis and comparable burden of nonalcoholic steatohepatitis between males and females. Dig Dis. 2023;41(6):900-12. DOI:10.1159/000533946
32. Chung J, Park HS, Kim YJ, et al. Association of Hepatic Steatosis Index with nonalcoholic fatty liver disease diagnosed by non-enhanced CT in a screening population. Diagnostics (Basel). 2021;11(12):2168. DOI:10.3390/diagnostics11122168
________________________________________________
2. Amini-Salehi E, Letafatkar N, Norouzi N, et al. Global prevalence of nonalcoholic fatty liver disease: an updated meta-analysis on 78 million population over 38 countries. Arch Med Res. 2024;55(6):103043. DOI:10.1016/j.arcmed.2024.103043
3. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-86. DOI:10.1097/HEP.0000000000000520
4. Pavlov ChS, Teplyuk DA, Lazebnik LB, et al. The clinician's view on the advantages and contradictions of the new nomenclature of steatotic liver disease: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(4):429-35 (in Russian). DOI:10.26442/00403660.2024.04.202747
5. Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
6. Drapkina OM, Martynov AI, Arutyunov GP, et al. Resolution of the Expert Forum "New therapeutic horizons of NAFLD". Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(2):186-93 (in Russian). DOI:10.26442/00403660.2024.02.202648
7. Bae JS, Lee DH, Suh KS, et al. Noninvasive assessment of hepatic steatosis using a pathologic reference standard: comparison of CT, MRI, and US-based techniques. Ultrasonography. 2022;41(2):344-54. DOI:10.14366/usg.21150
8. Kazi IN, Kuo L, Tsai E. Noninvasive methods for assessing liver fibrosis and steatosis. Gastroenterol Hepatol (N Y). 2024;20(1):21-9. PMID:38405045
9. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-62. DOI:10.1016/j.eprac.2022.03.010
10. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2024;81(3):492-542. DOI:10.1016/j.jhep.2024.04.031
11. Farrell GC, McCullough AJ, Day CP. (Eds.) Non-alcoholic fatty liver disease: A practical guide. New York: Wiley Blackwell, 2013.
12. Chitturi S, Wong VW, Chan WK, et al. The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease Guidelines 2017 – Part 2: Management and special groups. J Gastroenterol Hepatol. 2018;33(1):86-98. DOI:10.1111/jgh.13856
13. Brunt EM. Nonalcoholic fatty liver disease: Pros and cons of histologic systems of evaluation. Int J Mol Sci. 2016;17(1):97. DOI:10.3390/ijms17010097
14. Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound methods for the assessment of liver steatosis: A critical appraisal. Diagnostics (Basel). 2022;12(10):2287. DOI:10.3390/diagnostics12102287
15. Cao YT, Xiang LL, Qi F, et al. Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. EClinicalMedicine. 2022;51:101547. DOI:10.1016/j.eclinm.2022.101547
16. Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: A meta-analysis. Eur Radiol. 2019;29(7):3564-73. DOI:10.1007/s00330-019-06072-4
17. Wang XM, Zhang XJ, Ma L. Diagnostic performance of magnetic resonance technology in detecting steatosis or fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Medicine (Baltimore). 2018;97(21):e10605. DOI:10.1097/MD.0000000000010605
18. Jawahar A, Gonzalez B, Balasubramanian N, et al. Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol. 2020;32(2):216-21. DOI:10.1097/MEG.0000000000001502
19. Byun J, Lee SS, Sung YS, et al. CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: Development and validation of diagnostic cut-off values in a large cohort with pathological reference standard. Eur Radiol. 2019;29(8):4427-35. DOI:10.1007/s00330-018-5905-1
20. Park HJ, Kim KW, Kwon HJ, et al. CT-based visual grading system for assessment of hepatic steatosis: Diagnostic performance and interobserver agreement. Hepatol Int. 2022;16(5):1075-84. DOI:10.1007/s12072-022-10373-0
21. Guo Z, Blake GM, Li K, et al. Liver fat content measurement with quantitative CT validated against MRI proton density fat fraction: A prospective study of 400 healthy volunteers. Radiology. 2020;294(1):89-97. DOI:10.1148/radiol.2019190467
22. Hu N, Yan G, Tang M, et al. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp. 2023;7(1):72. DOI:10.1186/s41747-023-00387-0
23. Engelke K. Quantitative computed tomography – Current status and new developments. J Clin Densitom. 2017;20(3):309-21. DOI:10.1016/j.jocd.2017.06.017
24. Starekova J, Hernando D, Pickhardt PJ, Reeder SB. Quantification of liver fat content with CT and MRI: State of the art. Radiology. 2021;301(2):250-62. DOI:10.1148/radiol.2021204288
25. Jophlin LL, Singal AK, Bataller R, et al. ACG Clinical Guideline: Alcohol-associated liver disease. Am J Gastroenterol. 2024;119(1):30-54. DOI:10.14309/ajg.0000000000002572
26. Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42(7):503-8. DOI:10.1016/j.dld.2009.08.002
27. Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 2012;199(1):44-7. DOI:10.2214/AJR.11.7838
28. Lebre MA, Vacavant A, Grand-Brochier M, et al. Automatic segmentation methods for liver and hepatic vessels from CT and MRI volumes, applied to the Couinaud scheme. Comput Biol Med. 2019;110:42-51. DOI:10.1016/j.compbiomed.2019.04.014
29. Wong VW, Ekstedt M, Wong GL, Hagström H. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023;79(3):842-52. DOI:10.1016/j.jhep.2023.04.036
30. DiStefano JK, Gerhard GS. NAFLD in normal weight individuals. Diabetol Metab Syndr. 2022;14(1):45. DOI:10.1186/s13098-022-00814-z
31. Tan D, Chan KE, Wong ZY, et al. Global epidemiology of cirrhosis: Changing etiological basis and comparable burden of nonalcoholic steatohepatitis between males and females. Dig Dis. 2023;41(6):900-12. DOI:10.1159/000533946
32. Chung J, Park HS, Kim YJ, et al. Association of Hepatic Steatosis Index with nonalcoholic fatty liver disease diagnosed by non-enhanced CT in a screening population. Diagnostics (Basel). 2021;11(12):2168. DOI:10.3390/diagnostics11122168
Авторы
Т.А. Туранкова*1, А.Ю. Бражников1, Н.Г. Мороз1, А.В. Мудрова1, Д.Л. Варганова2, Ч.С. Павлов1,3
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2ГУЗ «Ульяновская областная клиническая больница», Ульяновск, Россия;
3ГБУЗ г. Москвы «Московский многопрофильный научно-клинический центр им. С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Россия
*turankova_t_a@staff.sechenov.ru
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia;
3Botkin Moscow Multidisciplinary Research and Clinical Center, Moscow, Russia
*turankova_t_a@staff.sechenov.ru
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2ГУЗ «Ульяновская областная клиническая больница», Ульяновск, Россия;
3ГБУЗ г. Москвы «Московский многопрофильный научно-клинический центр им. С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Россия
*turankova_t_a@staff.sechenov.ru
________________________________________________
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2Ulyanovsk Regional Clinical Hospital, Ulyanovsk, Russia;
3Botkin Moscow Multidisciplinary Research and Clinical Center, Moscow, Russia
*turankova_t_a@staff.sechenov.ru
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