Sebastiani Giada, Alberti Alfredo
Department of Clinical and Experimental Medicine, University of Padova, Italy.
World J Gastroenterol. 2006 Jun 21;12(23):3682-94. doi: 10.3748/wjg.v12.i23.3682.
Chronic liver diseases are very common worldwide, particularly those linked to viral hepatitis and to alcoholic and non-alcoholic fatty liver. Their natural history is variable and long-term evolution differs in individual patients. Optimised clinical management of compensated chronic liver diseases requires precise definition of the stage of liver fibrosis, the main determinant of prognosis and of most therapeutic decisions. Liver biopsy is the gold standard for assessment of hepatic fibrosis. However, it is invasive with possible complications, costly and prone to sampling errors. Many non-invasive markers of liver fibrosis have been recently proposed and assessed in the clinical setting as surrogates of liver biopsy. Direct markers are based on biochemical parameters directly linked to fibrogenesis while indirect markers use simple or more sophisticated parameters that correlate with liver fibrosis stages. Non-invasive markers of liver fibrosis have been tested in different forms of chronic liver disease and showed variable diagnostic performance, but accuracy rarely was above 75%-80%. Better results were obtained when markers were combined. On this line, we have recently proposed a set of algorithms that combine sequentially indirect non-invasive markers of liver fibrosis, reaching 90%-95% diagnostic accuracy with significant reduction in the need for liver biopsy. Based on available evidence, it can be anticipated that non-invasive markers of liver fibrosis and their combined use will soon become a most useful tool in the clinical management of many forms of chronic liver disease. However, their implementation is expected to reduce, but not to completely eliminate, the need for liver biopsy.
慢性肝病在全球范围内非常普遍，尤其是那些与病毒性肝炎、酒精性和非酒精性脂肪性肝病相关的疾病。它们的自然病程具有变异性，个体患者的长期演变也有所不同。代偿期慢性肝病的优化临床管理需要精确界定肝纤维化阶段，这是预后及大多数治疗决策的主要决定因素。肝活检是评估肝纤维化的金标准。然而，它具有侵入性，可能引发并发症，成本高昂且容易出现抽样误差。最近已经提出了许多肝纤维化的非侵入性标志物，并在临床环境中作为肝活检的替代指标进行评估。直接标志物基于与纤维生成直接相关的生化参数，而间接标志物则使用与肝纤维化阶段相关的简单或更复杂的参数。肝纤维化的非侵入性标志物已在不同形式的慢性肝病中进行了测试，显示出不同的诊断性能，但准确率很少超过75%-80%。标志物联合使用时能获得更好的结果。在此方面，我们最近提出了一组算法，依次组合肝纤维化的间接非侵入性标志物，诊断准确率达到90%-95%，同时显著减少了肝活检的需求。基于现有证据，可以预期肝纤维化的非侵入性标志物及其联合使用将很快成为多种慢性肝病临床管理中非常有用的工具。然而，预计它们的应用将减少，但不会完全消除肝活检的需求。
