1st Department of Internal Medicine, P.J. Safárik University, Kosice, Slovakia.
Clin Chim Acta. 2010 Aug 5;411(15-16):1009-17. doi: 10.1016/j.cca.2010.04.009. Epub 2010 Apr 23.
Fibrogenesis is a typical reaction of the liver to injury. In the case of overstimulation of fibrogenesis clinically significant fibrosis and, eventually, cirrhosis occur. Treatment of liver cirrhosis is limited, therefore it is important to screen and monitor patients at risk of cirrhosis. Noninvasive parameters are ideal for this purpose due to their risk profile and repeatability.
Systematic review of literature.
Among large number of proposed biomarkers, there is a distinct difference between two groups or classes. Class I biomarkers are associated with the process of fibrogenesis, their presence in the serum is the result of the increased turnover of extracellular matrix. Class II biomarkers and their combinations are mostly markers of liver function or structural damage. We have identified 27 Class I and 13 Class II biomarkers that have been proposed in the literature. We have evaluated in detail those which reached limited clinical application.
General clinical acceptance of these biomarkers is low because of various drawbacks. Simple and readily available biomarkers have low accuracy in predicting liver fibrosis and more advanced markers have low cost-benefit ratio. Therefore liver biopsy remains the "gold standard" for diagnosis of fibrosis. However potential noninvasive alternatives exist and their implementation could be valuable.
肝纤维化是肝脏对损伤的典型反应。在肝纤维化过度刺激的情况下，临床上会出现明显的纤维化，并最终导致肝硬化。肝硬化的治疗方法有限，因此对处于肝硬化风险中的患者进行筛查和监测非常重要。由于非侵入性参数具有风险特征和可重复性，因此非常适合用于此目的。
系统文献回顾。
在大量提出的生物标志物中，有两组或两类存在明显差异。I 类生物标志物与纤维化过程有关，其在血清中的存在是细胞外基质周转率增加的结果。II 类生物标志物及其组合大多是肝功能或结构损伤的标志物。我们已经在文献中确定了 27 种 I 类和 13 种 II 类生物标志物。我们详细评估了那些已经达到有限临床应用的生物标志物。
由于存在各种缺陷，这些生物标志物的一般临床接受度较低。简单且易于获得的生物标志物在预测肝纤维化方面准确性较低，而更先进的标志物则具有较低的成本效益比。因此，肝活检仍然是纤维化诊断的“金标准”。然而，确实存在潜在的非侵入性替代方法，其实施可能具有价值。
