Пункционная биопсия печени - прошлое или настоящее?

Abstract

The objective: To determine the diagnostic accuracy of non-invasive methods of diagnosis of liver fibrosis, as well as to analyze the interaction of laboratory parameters and the stage of liver fibrosis. Patients and methods. The work was performed in the infectious Department of 5 EKG of VNG of the Russian Federation in Yekaterinburg, 168 patients with CHC participated in the study. Before the administration of antiviral treatment to all CHC patients diagnosed with stage of liver fibrosis using three methods: needle biopsy of the liver, fibroelastometry and FibroTest. In the future, the sensitivity and specificity of non-invasive diagnostic methods depending on the stage of liver fibrosis were determined. Results. According to the results of liver puncture biopsy, patients with CHC depending on the stage of fibrosis were distributed as follows: with minimal fibrosis (F0-1) - 50.6% (85 people), moderate fibrosis (F2) - 25.6% (43 people), with severe fibrosis (F3) - 11.9% (20 people) and liver cirrhosis (F4) - 11.9% (20 people). According ROC curve analysis FibroTest highly informative only at the stage F4 fibrosis (AUROC=0,972), whereas fibroelastometry effective in severe F3 fibrosis (AUROC=0,847), and cirrhosis F4 the biopsies and elastography almost comparable (AUROC=0,994). In most patients with CGS at the stage of minimal and moderate fibrosis F≤2 it is advisable to use at least two non-invasive methods of diagnosis of liver fibrosis. Puncture liver biopsy is still a universal method of assessing the stage of liver fibrosis in patients with chronic viral infection. Conclusion. The sensitivity and specificity of noninvasive diagnostic methods for liver fibrosis in patients with CGS at stage F≤2 is unsatisfactory. In order to determine the true picture of the pathological process, a puncture liver biopsy is necessary.