Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina, USA.
Curr Opin Gastroenterol. 2010 May;26(3):227-33. doi: 10.1097/MOG.0b013e3283383c68.
Improved understanding of the pathophysiology of fibrosis and recent technological advances have resulted in the development of several serum biomarkers and imaging tools as noninvasive alternatives to biopsy. This review highlights some of the recent advances and potential application of these tools in clinical practice.
Several newer approaches have been used to improve the semiquantitative histological assessment of fibrosis in relation to biomarker development. These include statistical considerations, smooth muscle actin morphometry, and emerging microscopy techniques to quantify fibrillar collagen. Serum marker panels, initially developed for determining disease stage in chronic hepatitis C infection, have now been adapted for use in nonalcoholic fatty liver disease. Genetic markers of disease progression have been validated, and newer proteomic technologies are increasingly being applied towards biomarker discovery. A sequential approach or the combination of serum markers and transient elastography is able to significantly reduce the need for biopsy for the diagnosis of cirrhosis. Serum markers also appear to provide useful prognostic information in end-stage liver disease. Newer imaging methods and breath tests require further validation, but appear promising adjunctive techniques for prediction of advanced stage fibrosis and providing functional assessment.
Current noninvasive tools have potential diagnostic and prognostic utility for end-stage liver disease. Adapting these methods into clinical practice remains a challenge.
纤维化病理生理学的深入理解和最近的技术进步促使了几种血清生物标志物和成像工具的发展，这些工具可作为活检的非侵入性替代方法。这篇综述强调了这些工具在临床实践中的一些最新进展和潜在应用。
为了改善与生物标志物开发相关的纤维化的半定量组织学评估，已经采用了几种新方法。这些方法包括统计考虑、平滑肌肌动蛋白形态计量学以及新兴的显微镜技术，以定量纤维胶原。最初为慢性丙型肝炎感染确定疾病阶段而开发的血清标志物组合现在已被改编用于非酒精性脂肪性肝病。疾病进展的遗传标志物已经得到验证，新的蛋白质组学技术越来越多地应用于生物标志物的发现。血清标志物和瞬时弹性成像的序贯方法或组合能够显著减少对肝硬化诊断的活检需求。血清标志物在终末期肝病中似乎也提供了有用的预后信息。较新的成像方法和呼吸测试需要进一步验证，但它们似乎是预测晚期纤维化和提供功能评估的有前途的辅助技术。
目前的非侵入性工具对终末期肝病具有潜在的诊断和预后效用。将这些方法应用于临床实践仍然是一个挑战。
