Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector10628010.17816/0869-2106-2021-27-4-373-384ReviewsНаучные обзорыReview ArticleDiagnostic and risk stratification aspects of liver fibrosis progression in chronic hepatitis B and C viral infectionОсобенности диагностики и стратификации риска прогрессирования фиброза печени при хронической HBV и HCV инфекцииhttps://orcid.org/0000-0001-9809-8015GarbuzenkoDmitry V.ГарбузенкоДмитрий Викторович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

garb@inbox.ruSouth Ural State Medical UniversityЮжно-Уральский государственный медицинский университет1507202127437338414042022Copyright ©; 2021, Eco-VectorCopyright ©; 2021, ООО "Эко-Вектор"2021Eco-VectorООО "Эко-Вектор"https://medjrf.com/0869-2106/article/view/106280

The treatment strategy and prognosis for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection largely depend on the presence and stage of liver fibrosis. This study aimed to reveal the diagnostic and risk stratification aspects of liver fibrosis progression in patients with chronic HBV and HCV infection. The PubMed database, the Google Scholar search engine, the Cochrane systematic reviews, and the scientific electronic library eLibrary.Ru, as well as the reference lists, were used to search for scientific articles. Relevant aims of the publication review were selected over the period from 2005 to 2021 using the keywords “chronic HBV infection,” “chronic HCV infection,” “liver fibrosis,” “diagnostics,” and “prognosis.” Inclusion criteria were limited to liver fibrosis diagnostics in chronic HBV and HCV infection. Considering biopsy as a gold standard for studying morphological abnormalities in the liver, its indications for serum biomarkers of liver fibrosis and imaging methods assessments are currently significantly limited. Additionally, noninvasive methods are required to monitor the progression of liver fibrosis. The combined use of two unrelated noninvasive methods, for example, transient elastography and one of the serum biomarkers, can improve the accuracy of clinically diagnosing significant liver fibrosis. Considering that the development of liver fibrosis is an unfavorable event in the natural course of chronic HBV and HCV infection, the distribution of patients by risk groups will increase the efficiency of antiviral therapy and improve the disease prognosis.

Стратегия лечения и прогноз при хронической HBV и HCV инфекции во многом зависят от наличия и стадии фиброза печени. Цель обзора — показать особенности диагностики и стратификации риска прогрессирования фиброза печени у пациентов с хронической HBV и HCV инфекцией. Для поиска научных статей использовались база данных PubMed, поисковая система Google Scholar, Кокрановские систематические обзоры, научная электронная библиотека eLibrary.ru, а также пристатейные списки литературы. Соответствующие цели обзора публикации отбирались за период с 2005 по 2021 год по ключевым словам: «хроническая HBV инфекция», «хроническая HCV инфекция», «фиброз печени», «диагностика», «прогноз». Критерии включения ограничивались диагностикой фиброза печени при хронической HBV и HCV инфекции. Несмотря на то, что «золотым стандартом» изучения морфологических нарушений в печени считается биопсия, показания к ней на фоне внедрения сывороточных биомаркеров фиброза печени и визуализационных способов его оценки в настоящее время существенно ограничены. Кроме того, неинвазивные методы могут быть применены для мониторинга прогрессирования фиброза печени. Повысить точность диагностики клинически значимого фиброза печени позволяет комбинированное использование двух не связанных друг с другом неинвазивных методов, например, транзиентной эластографии и одного из сывороточных биомаркеров. Учитывая, что развитие фиброза печени является неблагоприятным событием естественного течения хронической HBV и HCV инфекции, распределение пациентов по группам риска даст возможность повысить эффективность противовирусной терапии и улучшит прогноз заболевания.

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