NON-INVASIVE DIAGNOSTIC CRITERIA FOR STRUCTURAL LIVER CHANGES IN PATIENTS WITH CHRONIC HEPATITIS ASSOCIATED WITH VIRUS C

Stepanov Y. M., Konenko I. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Chronic liver diseases rate among the first in the gastrointestinal tract pathology, which is associated with their prevalence, severity and often adverse outcome of treatment. According to various studies, the chronic hepatitis (СНС) with subsequent progression to cirrhosis rates number 2-4 among the causes of hospitalization and disability. Purpose of the study to determine non-invasive diagnostic criteria for structural changes in the liver in patients with CHC. Object and methods. 94 patients with CHC were examined. All the patients underwent a sonological examination of liver and spleen on the scanner Ultrasign (Ukraine-Switzerland). The presence and stage of liver fibrosis were diagnosed by Young’s modulus by shear wave elastography (SWE). Research results. According to the data obtained from the SWE of the liver, 15 (16.0%) patients with CHC had no fibrotic changes, 42 (44.7%) were diagnosed with moderate fibrosis and 37 (39.3%) had marked fibrosis. The analysis of the frequency of detection of structural changes in the liver parenchyma showed that structural liver changes in the form of heterogeneity were observed in 76 of 94 (80.9%) patients with CHC. In this case, the frequency of this symptom in severe fibrosis group was 1.5 times higher than in the group without fibrosis (χ² = 13.65; p <0.001) and than in patients with moderate fibrosis (χ² = 13.71; p < 0.001). The frequency of detection of coarse-grained liver parenchyma in patients with CHC with severe fibrosis was 86.5%, which is 4.0 times higher than in the stage of moderate fibrosis (χ² = 33.35; p <0.001). In the course of correlation analysis, the stiffness of the liver was directly related to its coarse-grained structure (r = 0.65; p <0.05) and the thickened walls of portal triads (r = 0.62; p <0.05). Imaging the thickened walls of portal triads and detecting the increased echogenicity significantly increase the probability of diagnosing liver fibrosis in patients with CHC (OR = 154, p <0.001 and OR = 24.41, p <0.001, respectively). As a result of the correlation analysis, the liver stiffness according to SWE in patients with CHC was observed to directly correlate with the splenic stiffness, in kPa (r = 0.81; p <0.001) and in m/s (r = 0.76; p < 0.001). The obtained values of the area under the ROC curve for both Young's modulus (AUS = 0.858, p <0.001) and the shear wave propagation rate (AUS = 0.812, p <0.001) testify to the high quality of the proposed diagnostic model. Conclusions: the diagnostic criteria for the formation of the risk group as for the development of fibrotic changes in patients with CHC, according to the ultrasound in B-mode, are imaging of the thickened walls of portal triads (OR = 154, p <0,001) and an increased liver echogenicity (OR = 24,41, p <0,001 ). The coarse-grained liver structure on the gray ultrasound scale (OR = 34.13, p <0.001) and the spleen stiffness according to SWE (OR = 24.58, p <0.001) are the non-invasive diagnostic indicators of severe liver fibrosis in patients with CHC.

chronic hepatitis C, liver fibrosis, shear wave elastography, structural liver changes, spleen.

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«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 199-203 pages, index UDK 616.36 – 002 – 071

10.29254/2077-4214-2019-4-2-154-199-203