[Guidelines for the diagnosis and treatment of adult patients with hepatitis C]


Non-invasive diagnosis of liver fibrosis
Diagnostic accuracy of elastometry (elastography) and laboratory tests of blood (FibroTest and FibroMeter V) in the noninvasive assessment of liver fibrosis is proved on the basis of Russian and foreign research. Estimation accuracy is increased when combined elastometry and laboratory tests.
Elastometry carried out on the device 'Fibroscan' and allows to estimate the stiffness of the liver based on computer analysis of the velocity of propagation of mechanical waves. The use of elastography is possible at all stages of liver fibrosis (F0-F4) in patients with chronic hepatitis C.
Advantages of the method:
1. Noninvasive
2. Reproducibility
3. The estimated amount of liver tissue is 100-200 times greater than the volume estimated by biopsy
4. Short duration of the survey (an average of 5 minutes) and ease of use
5. Immediate results
6. Evaluation of the effectiveness of therapy
7. Opportunity to survey children
Interpretation of the results may be difficult in the following cases:
1. Overweight (BMI>35 kg/m2)
2. Significant hepatic steatosis
3. High biochemical activity (ALT / AST more than three times higher than normal)
Success Criteria Survey:
1. Interquartile ratio (IQR) does not exceed 30% of the stiffness
2. At least 10 verified measurements at one point
3. Not less than 60% successful measurements

FibroMeter includes the following 5 parameters of blood: alpha 2-macroglobulin, gamma-glutamyl transpeptidase, urea, prothrombin index, platelet. It allows to assess liver fibrosis by using discriminant function. FibroMeter allows to differentiate mild fibrosis (F1-F2) from significant fibrosis (F3) and cirrhosis (F4) in patients with chronic hepatitis C.
Interpretation of the results may be difficult in the following cases:
1. Age less than 18 years
2. Acute hepatitis of any etiology
3. During treatment of liver disease (allowed only for dynamic monitoring)
4. Renal failure
5. Pregnancy