Guéchot Jérôme
Service de Biochimie A, AP-HP, Hôpital Saint-Antoine, Paris.
Presse Med. 2006 Sep;35(9 Pt 2):1317-26. doi: 10.1016/s0755-4982(06)74811-4.
Development of liver fibrosis, which leads to cirrhosis, is the principal complication of all chronic liver diseases, regardless of their cause. Knowledge of the existence and severity of fibrosis is important from diagnostic and prognostic viewpoints. Its assessment plays an essential role in the treatment decision and makes it possible to assess the risk of progression to cirrhosis and the onset of its complications. Histologic examination of the liver remains the reference examination for assessing the extent of fibrosis during chronic liver disease. Nonetheless, the number of patients needing assessment, the risks of the punch-biopsy and the cost of this invasive examination have led many to propose other tools to assess fibrosis. Some standard indicators (transaminases, platelets, prothrombin time) have long been recognized as indirect markers of extensive fibrosis. More recently, progress in our knowledge of the mechanisms of liver fibrogenesis have made it possible to identify different peripheral blood components that may be of clinical interest. Thus serum assays of elements of the extracellular matrix, their decay products, or enzymes involved in their metabolism have been proposed as noninvasive indicators. Among these, hyaluronic acid appears the most interesting. For several years, scores have been calculated with algorithms that combine several indicators determined simultaneously to assess fibrosis in patients with hepatitis C and sometimes other chronic liver diseases. The Fibrotest is the best validated and most widely used of these. Finally, Fibroscan is a device for the diagnosis and quantification of hepatic fibrosis, based on the technique of transient elastography. The relative roles of these noninvasive markers and the value of their combinations must still be determined.
肝纤维化发展至肝硬化是所有慢性肝病的主要并发症，无论其病因如何。从诊断和预后角度来看，了解纤维化的存在及其严重程度至关重要。纤维化评估在治疗决策中起着至关重要的作用，并且能够评估进展为肝硬化及其并发症发生的风险。肝脏组织学检查仍然是评估慢性肝病纤维化程度的参考检查。尽管如此，需要评估的患者数量、穿刺活检的风险以及这种侵入性检查的费用促使许多人提出其他评估纤维化的工具。一些标准指标（转氨酶、血小板、凝血酶原时间）长期以来一直被认为是广泛纤维化的间接标志物。最近，我们对肝纤维化发生机制的认识取得了进展，使得识别可能具有临床意义的不同外周血成分成为可能。因此，有人提出检测细胞外基质成分、其降解产物或参与其代谢的酶的血清学检查作为非侵入性指标。其中，透明质酸似乎最具吸引力。多年来，通过将同时测定的多个指标相结合的算法计算出评分，以评估丙型肝炎患者以及有时其他慢性肝病患者的纤维化程度。Fibrotest是其中验证最佳且应用最广泛的。最后，Fibroscan是一种基于瞬时弹性成像技术的肝纤维化诊断和定量设备。这些非侵入性标志物的相对作用及其组合的价值仍有待确定。
