Zois C D, Baltayiannis G H, Karayiannis P, Tsianos E V
1st Department of Internal Medicine and Hepato-Gastroenterology Unit, Medical School, University of Ioannina, Ioannina, Greece.
Aliment Pharmacol Ther. 2008 Nov 15;28(10):1175-87. doi: 10.1111/j.1365-2036.2008.03840.x. Epub 2008 Aug 30.
Hepatic fibrosis occurs in response to chronic liver injury, regardless of the cause. An impressive amount of knowledge concerning the pathogenesis and treatment of liver fibrosis has emerged over the past few years. The hallmark of this event is the activation of the hepatic stellate cell. The latter event causes accumulation of extracellular matrix and formation of scar, leading to deterioration in hepatic function.
To assess chronic liver injury, many invasive and non-invasive methods have been suggested.
Although transient elastography, image analysis of fractal geometry and fibrotest with actitest have been used in clinical practice, liver biopsy remains the recommended choice, especially when histological staging of fibrosis or response to treatment is needed.
The recent advances in anti-viral therapy have resulted in many reports on fibrosis and even on cirrhosis regression, especially early and in young people. A number of new agents have been suggested for the treatment of fibrosis, with promising results in animals; however, their efficacy in humans remains to be elucidated. The investigation of heterogeneity and plasticity of hepatic stellate cells is a topic of scientific interest and may result in improvements in patient management.
无论病因如何，肝纤维化均因慢性肝损伤而发生。在过去几年中，已经涌现出大量关于肝纤维化发病机制和治疗的知识。这一过程的标志是肝星状细胞的激活。这一事件会导致细胞外基质的积累和瘢痕形成，进而导致肝功能恶化。
为评估慢性肝损伤，人们提出了许多侵入性和非侵入性方法。
尽管瞬时弹性成像、分形几何图像分析以及联合Actitest的FibroTest已应用于临床实践，但肝活检仍是推荐的选择，尤其是在需要进行纤维化组织学分期或评估治疗反应时。
抗病毒治疗的最新进展催生了许多关于纤维化甚至肝硬化逆转的报道，尤其是在早期和年轻人中。已经提出了一些新的药物用于治疗纤维化，在动物实验中取得了有前景的结果；然而，它们在人体中的疗效仍有待阐明。肝星状细胞的异质性和可塑性研究是一个具有科学意义的课题，可能会改善患者的管理。
