Ultrasound Score of Liver Steatosis Severity in the Diagnosis of Peripheral Arterial Atherosclerosis in Patients with Nonalcoholic Fatty Liver Disease
https://doi.org/10.20514/2226-6704-2023-13-3-196-202
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a widespread disease closely associated with obesity and metabolic disorders. Noninvasive instrumental markers are of great importance in the diagnosis of NAFLD. The aim of the present investigation was to study the correlation of Hamaguchi score with the prevalence of peripheral arterial atherosclerosis and to evaluate the diagnostic value of Hamaguchi score in relation to the presence of carotid and lower limb arterial stenoses. Materials and Methods. All the participants underwent duplex scanning of the arteries of the carotid basin and the arteries of the lower extremities, and abdominal ultrasound examination. Results. The study involved 175 patients, including 72 men and 103 women. Median age of the patients was 50 years. Combined atherosclerosis of carotid arteries and the arteries of the lower extremities was detected in 76 (43,4 %) patients. Median severity of hepatic steatosis according to Hamaguchi score was 2 points. Significantly higher Hamaguchi score values (p=0,026) were observed in the group of patients with combined atherosclerosis of carotid arteries and lower limb arteries. According to logistic regression analysis, a one unit increase in Hamaguchi score was associated with a 1,192-fold (95 % CI 1,023-1,387) increase in the relative risk of finding combined atherosclerosis of two basins (carotid and lower extremity arteries). According to ROC-analysis, increasing Hamaguchi score>2 points allowed to diagnose combined stenoses of carotid and lower limb arteries with sensitivity of 52,6 % and specificity of 63,6 % (AUC=0,596; p=0,024). Conclusion. In patients with NAFLD the Hamaguchi score>2 made it possible to diagnose combined stenoses of the carotid and lower extremity arteries with a sensitivity of 52,6 % and specificity of 63,6 %.
About the Authors
A. S. KuznetsovaRussian Federation
Chelyabinsk
A. I. Dolgushina
Russian Federation
Chelyabinsk
V. V. Pospelov
Russian Federation
Chelyabinsk
T. A. Sokolova
Russian Federation
E. V. Lebedev
Russian Federation
Chelyabinsk
V. V. Genkel
Russian Federation
Chelyabinsk
References
1. Lazarus J.V., Mark H.E., Villota-Rivas M. et al. The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge? J Hepatol. 2022; 76(4): 771-780. doi: 10.1016/j.jhep.2021.10.025.
2. Drapkina O.M., Korneeva O.N. Continuum of nonalcoholic fatty liver disease: from liver steatosis to cardiovascular risk. Rational pharmacotherapy in cardiology. 2016; 12(4): 424-429. [In Russian]. doi: 10.20996/1819-6446-2016-12-4-424-429.
3. Kim O.T., Drapkina O.M. The obesity epidemic through the prism of evolutionary processes. Cardiovascular Therapy and Prevention. 2022; 21(1): 72-79. [In Russian]. doi: 10.15829/1728-8800-2022-3109.
4. Ye Q., Zou B., Yeo Y.H. et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(8): 739-752. doi: 10.1016/S2468-1253(20)30077-7.
5. Targher G., Byrne C.D., Lonardo A. et al. Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. Journal of Hepatology. 2016; 65(3): 589-600. doi: 10.1016/j. jhep.2016.05.013.
6. Wu S., Wu F., Ding Y. et al. Association of nonalcoholic fatty liver disease with major adverse cardiovascular events: a systematic review and meta-analysis. Sci Rep. 2016; 6: 33386. doi: 10.1038/srep33386.
7. Angulo P., Kleiner D.E., Dam-Larsen S. et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015; 149(2): 389-97.e10. doi: 10.1053/j.gastro.2015.04.043.
8. Zou B., Yeo Y.H., Cheung R. et al. Fatty Liver Index and Development of Cardiovascular Disease: Findings from the UK Biobank. Dig Dis Sci. 2021; 66(6): 2092-2100. doi: 10.1007/s10620-021-06954-y.
9. Wang C., Cai Z., Deng X. et al. Association of Hepatic Steatosis Index and Fatty Liver Index with Carotid Atherosclerosis in Type 2 Diabetes. Int J Med Sci. 2021; 18(14): 3280-3289. doi: 10.7150/ijms.62010.
10. Gulyaeva I.L., Bulatova I.A., Pestrenin L.D. The role of vasculo-endothelial growth factor in the pathogenesis of hepatic steatosis and dyslipidemia. Pathological Physiology and Experimental Therapy. 2020; 64(4): 31-36. [In Russian]. doi: 10.25557/0031-2991.2020.04.31-36.
11. Pastori D., Baratta F., Novo M. et al. Remnant Lipoprotein Cholesterol and Cardiovascular and Cerebrovascular Events in Patients with Non-Alcoholic Fatty Liver Disease. J Clin Med. 2018; 7(11): 378. doi: 10.3390/jcm7110378.
12. Lazebnik L.B., Golovanova E.V., Turkina S.V., et al. Nonalcoholic fatty liver disease in adults: clinic, diagnosis, treatment. Recommendations for general practitioners, third version. Experimental and Clinical Gastroenterology. 2021;1(185):4-52. [In Russian]. doi: 10.31146/16828658-ecg-185-1-4-52
13. Genkel V.V., Kuznetsova A.S., Lebedev E.V. et al. Prognostic significance of atherosclerosis of one or two vascular systems in patients with high and very high cardiovascular risk. Cardiovascular Therapy and Prevention. 2021; 20(2): 2669. [In Russian]. doi:10.15829/1728-8800-2021-2669.
14. Hye-Yeon Choi. Carotid duplex ultrasound: interpretations and clinical applications. Annals of Clinical Neurophysiology 2021; 23(2): 82-91. doi.org/10.14253/acn.2021.23.2.82.
15. Hutchinson Stuart J. Ultrasound diagnostics in angiology and vascular surgery / Stuart J. Hutchinson, Katherine K. Holmes ; translation from English ed. by A.I. Kirienko, D.A. Churikov. — Moscow : GEOTARMedia, 2018. — рр. 400
16. Kulikov V.P. Ultrasound diagnosis of vascular diseases / Edited by V.P. Kulikov. 1st edition. — Moscow: LLC Firma STROM, 2007 — рр. 512 [In Russian].
17. Hamaguchi M., Kojima T., Itoh Y. et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol. 2007; 102(12): 2708-15. doi: 10.1111/j.15720241.2007.01526.x.
18. Shlyakhto EV, Nedogoda SV, Konradi A.O. National clinical recommendations “Diagnosis, treatment, prevention of obesity and associated diseases.” St. Petersburg, 2017; 164 р. [In Russian].
19. Blüher M. Metabolically Healthy Obesity. Endocr Rev. 2020;41(3):bnaa004. doi: 10.1210/endrev/bnaa004.
20. Grzhibovsky A.M., Ivanov S.V., Gorbatova M.A. Ecological (correlational) studies in public health. Science and health care. 2015;5:5-18 [In Russian].
21. Evstifeeva S.E., Shalnova S.A., Kutsenko V.A. et al. Рrevalence of non-alcoholic fatty liver disease among the working-age population: associations with socio-demographic indicators and behavioral risk factors (ESSE RF-2 data). Cardiovascular Therapy and Prevention. 2022; 21(9): 40-49. [In Russian]. doi: 10.15829/1728-8800-2022-3356.
22. Nelidova AV, Livzan MA, Nikolaev NA et al. Cardiovascular disease and nonalcoholic fatty liver disease: relationship and pathogenetic aspects of pharmacotherapy. Rational Pharmacotherapy in Cardiology. 2021; 17(6): 880-888. [In Russian]. doi. org/10.20996/1819-6446-2021-12-14
23. Sheptulina A.F., Yafarova A.A., Kiselev A.R. et al. Comparative characterization of the gut microbiome in patients with nonalcoholic fatty liver disease and healthy volunteers. Preventive Medicine. 2022; 25(5-2): 36. [In Russian].
24. Sookoian S, Pirola CJ. Non-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review. J Hepatol. 2008; 49(4): 600-7. doi: 10.1016/j.jhep.2008.06.012.
25. Tang A.S.P., Chan K.E., Quek J. et al. Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals. Clin Mol Hepatol. 2022; 28(3): 483-496. doi: 10.3350/cmh.2021.0406
26. Candusso G., Catena C., Soardo G. et al. Non-invasive biochemical scores of nafld and carotid morphofunctional alterations in never treated essential hypertensive patients. Journal of Hypertension. 2022; 40:e24. doi: 10.1097/01.hjh.0000835496.54152.9d.
27. Marco Delle Monache, R. Cecere, et al. Correlation between ultrasonographic Hamaguchi score, insulin resistance, obesity and fatty liver indexes in patients affected by NAFLD. Digestive and Liver Disease. 2013; 45: S36-S37. doi: 10.1016/S1590-8658(13)60111-5
Review
For citations:
Kuznetsova A.S., Dolgushina A.I., Pospelov V.V., Sokolova T.A., Lebedev E.V., Genkel V.V. Ultrasound Score of Liver Steatosis Severity in the Diagnosis of Peripheral Arterial Atherosclerosis in Patients with Nonalcoholic Fatty Liver Disease. The Russian Archives of Internal Medicine. 2023;13(3):196-202. https://doi.org/10.20514/2226-6704-2023-13-3-196-202