ASSESSMENT OF LIVER FIBROSIS IN PATIENTS WITH DIABETES MELLITUS


I.G. Bakulin, E.V. Vinnytskaya, Yu.G. Sandler, V.A. Keiyan, S.V.Rodionova

SBHCI "Moscow Clinical Research and Practical Center" of Moscow Healthcare Department
Patients with type 2 diabetes mellitus (DM2) are at high risk of nonalcoholic fatty liver disease (NAFLD), which includes a range of clinical and morphological characteristics: steatosis, nonalcoholic steatohepatitis (NASH) with development of liver fibrosis (LF) and cirrhosis (LC). Most DM2 patients are unaware of their NAFLD. Because of the high prevalence of DM2, liver biopsy can’t be carried out often for the diagnosis of liver fibrosis (LF).
Objective: Assessment of results of screening of LF in DM2 patients using non-invasive tests: liver fibroelastometry (FEM), biomarkers (FibroTest) and determination of their comparative diagnostic significance.
Methods: A total of 67 patients aged 30 to 82 years, treated at the endocrinology department with a diagnosis of type 2 diabetes mellitus underwent examination. The statistical evaluation of the reliability of both methods using the ROC-analysis, correlation analysis of various factors and the severity of LF according to FibroTest (FT) and liver fibroelastometry (FEM) was performed. The influence of various factors on the prognosis of LF was assessed using multiple logistic regression and ANOVA.
Results: According to the FEM and FT, liver fibrosis was detected in ≈ 12% cases; LF was absent in 33% cases according to the FT (F0) and in 44.8% - according FEM.. According to ROC-analysis, the quality and accuracy of the FT and FEM were regarded as good: AUROC-0.7 and AUROC-0.8, respectively. Reliability of FT and FEM for F-4 stage is rated as very good (AUROC for F4 – 0.86).
Conclusions: The diagnosis of LF in 67 patients with DM2 has showed that LF was identified in the DM2 in 11.7% at a random sample. These data indicate that the presence of DM2 is a risk factor for progression of LF, which requires screening for such patients. Non-invasive tests have good diagnostic accuracy in determining the LC. Further research is needed to identify predictors of progression of fibrosis and hepatic steatosis.

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About the Autors


I.G. Bakulin – Doctor of Medical Scineces, Prof., Head of the Department of Hepatology SBHCI "Moscow Clinical Research and Practical Center " of Moscow Healthcare Department; Head of the Medical Institute of Postgraduate Education of Physicians MSUFD, Moscow; e-mail: igbakulin@yandex.ru


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