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Liver Stiffness Evaluation in DM 2, Dr Nguyễn thị Hồng Anh

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Based on 45 cases of DM type II, liver stiffness increasing 40% and ARFI technique is comparable with transient elastographe (TE).

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Liver Stiffness Evaluation in DM 2, Dr Nguyễn thị Hồng Anh

  1. 1. NguyễnThị Hồng Anh, MD NguyễnThiện Hùng, MD MEDIC CENTERVIETNAM
  2. 2.  The prevalence of metabolic syndrome is increasing while the age of its onset is decreasing  Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide.  Fatty infiltration of the liver is quite frequent in patients with obesity, DM and metabolic syndrome.  Bi-directional, causal link between NAFLD and DM.  A percentage of NAFLD will develop nonalcoholic steatohepatitis (NASH), which can progress to liver cirrhosis.
  3. 3.  Accurate assessment of the degree of liver fibrosis is important for estimating prognosis and deciding on an appropriate course of treatment for cases of chronic liver disease with various etiologies.  Because of the inherent limitations of liver biopsy, there is a great need for noninvasive and reliable tests that accurately estimate the degree of liver fibrosis. Ultrasound elastography is considered a non-invasive, convenient, and precise technique to grade the degree of liver fibrosis by measuring liver stiffness.
  4. 4.  The aim of this small observed study was to evaluate a population of OPD diabetic patients regarding the severity of liver steatosis and liver fibrosis by ARFI imaging.
  5. 5.  Descriptive cross-section statistics  Assess liver steatosis (B mode transabdominal US)and liver fibrosis (ARFI imaging)  Inclusive criteria:  DM patients > 18 yrs  Exclusive criteria  Consumption beer / alcohol >20g/day  HBV, HCV  Drug induced hepatitis  Autoimmune hepatitis
  6. 6.  Steatosis severity:semi-quantitative scale/ B mode  S0 = no steatosis  S1 = mild steatosis  S2 = moderate steatosis  S3 = severe steatosis  Stages of liver fibrosis (ARFI technique)  F0 = 0,99 - 1,16 m/s  F1 = 1,16 - 1,25 m/s  F2 = 1,25 - 1,32 m/s  F3 = 1,32 - 1,56 m/s  F4 = 1,56 - 4,15 m/s
  7. 7.  45 type 2 diabetic patients (19 M, 26F).  Age=30-74.  Duration of acquired DM= first onset -20 years.  2 obese patients (4,4%), 11 over weight patients (24,44%)
  8. 8.  Significant fibrosis (F2-F3): 31.1% (14 cases) patients with or without steatosis.  Severe fibrosis (F4): 17.77% (8 cases) with steatosis.  100% severe steatosis (S3) are significant /severe fibrosis.  6,66% (3 cases) significant fibrosis (F2-F3) without steatosis: long time DM (7- 15 y) S0 S1 S2 S3 Total F0 2 2 2 0 6 F1 3 11 3 0 17 F2 1 3 1 1 6 F3 2 3 2 1 8 F4 0 4 1 3 8 Total 8 23 9 5 45
  9. 9.  Lower percentage ofVietnamese over weight / obese DM patients compared to western-american (2/45 obese +11/45 over weight #28,88%)  Lower percentage of male DM patient (19/45 #42,22%) because of inclusive criteria (non alcohol and negative HBV, HCV)  Liver steatosis diagnosed by ultrasound is very frequently found in type 2 DM patients (38/45#84,44%), a significance of them having moderate/severe steatosis (S2=9, S3=5; 14/38 #36,84%)
  10. 10.  A significant liver stiffness increase was found in more than 40% of DM patients and was not correspondence with steatosis severity. Fibrosis seems to depend on acquired DM duration.  But severe steatosis (S3) was concerned with significant /severe fibrosis.  ARFI technique is a fast, useful and valuable tool, as comparable as transient elastography in diabetic liver stiffness assessment.
  11. 11.  The best accuracy for ARFI in NAFLD patients occurred when distinguishing between patients with no or moderate fibrosis (F0 to F2) and those with severe fibrosis or cirrhosis (F3-F4).  The interference by obesity on theARFI technique was less conspicuous.
  12. 12. 1. A significant liver stiffness increase was found in more than 40% of DM patients. 2. Liver stiffness assessment in type 2 diabetic patients should be performed systematically to identify those with significant liver fibrosis. 3. ARFI technique is comparable withTE in liver stiffness assessment.
  13. 13. 1. Liver Stiffness Evaluation byTransient Elastography inType 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis -Ioan Sporea1, Ruxandra Mare1, Raluca Lupușoru1,Alexandra Sima2, Roxana Șirli1, Alina Popescu1, RomulusTimar2, J Gastrointestin Liver Dis, June 2016Vol. 25 No 2: 167-174. 2. Liver Stiffness in Nonalcoholic Fatty Liver Disease:A Comparison of Supersonic Shear Imaging,FibroScan, and ARFI With Liver Biopsy. HEPATOLOGY, Month 2015 3. Principles and clinical application of ultrasound elastography for diffuse liver disease-Woo Kyoung Jeong1, Hyo K. Lim1, Hyoung-Ki Lee2, Jae Moon Jo2,Yongsoo Kim3. Ultrasonography 33(3), July 2014

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