Prescrire Int. 2010 Feb;19(105):38-42.
Needle biopsy of the liver is considered the "gold-standard" for diagnosis of hepatic fibrosis and cirrhosis. However, it is not risk-free, lacks accuracy, and is poorly accepted by some patients. This review examines available literature on the use and diagnostic performance of non-invasive methods for assessment of hepatic fibrosis and cirrhosis in adults, based on the standard Prescrire methodology. Transient elastography (FibroScan) measures liver stiffness in kilopascals. The results are less reliable in patients with a thick chest wall, hepatic congestion of cardiac origin, and acute exacerbations of hepatitis. Transient elastography has been evaluated in more than 8000 patients, most of whom had chronic hepatitis C. With a cutoff value of about 7-8 kPa, elastography identified about 70% of patients with histological signs of moderate to severe fibrosis. With a cutoff of 14-15 kPa, it identified about 85% of patients with histological signs of cirrhosis. Transient elastography is reliable in detecting moderate to severe fibrosis and cirrhosis and in ruling out cirrhosis, but is less reliable in ruling out moderate fibrosis. Composite scores based on blood assay values and complex calculations are unreliable when at least one of the score components is influenced by intercurrent conditions. FibroTest, FibroMeter and Hepascore have been tested in several thousand patients with chronic hepatitis C. With the manufacturers' recommended cutoff values, FibroTest identifies about 70% of patients with histological signs of moderate to severe fibrosis and about 90% of patients with histological signs of cirrhosis. It can reliably diagnose or rule out moderate fibrosis, and diagnose cirrhosis. It is also very reliable in ruling out cirrhosis. Hepascore has similar diagnostic performance. FibroMeter has been less extensively evaluated but also seems to have diagnostic performance similar to that of FibroTest. Some studies suggest that FibroTest has similar accuracy in forms of liver fibrosis other than chronic hepatitis C. In practice, the main issue involved in making therapeutic decisions in patients with chronic hepatitis C is the risk-benefit balance of available treatments rather than precise diagnosis of fibrosis.
肝脏穿刺活检被认为是诊断肝纤维化和肝硬化的“金标准”。然而，它并非毫无风险，缺乏准确性，且一些患者难以接受。本综述基于标准的Prescrire方法，研究了关于评估成人肝纤维化和肝硬化的非侵入性方法的使用及诊断性能的现有文献。瞬时弹性成像（FibroScan）以千帕为单位测量肝脏硬度。在胸壁较厚、心脏源性肝充血以及肝炎急性加重的患者中，结果的可靠性较低。瞬时弹性成像已在8000多名患者中进行了评估，其中大多数患有慢性丙型肝炎。弹性成像以约7 - 8 kPa为临界值时，可识别出约70%有中度至重度纤维化组织学征象的患者。以14 - 15 kPa为临界值时，可识别出约85%有肝硬化组织学征象的患者。瞬时弹性成像在检测中度至重度纤维化和肝硬化以及排除肝硬化方面是可靠的，但在排除中度纤维化方面可靠性较低。当评分组件中的至少一项受并发疾病影响时，基于血液检测值和复杂计算的综合评分是不可靠的。FibroTest、FibroMeter和Hepascore已在数千名慢性丙型肝炎患者中进行了测试。采用制造商推荐的临界值时，FibroTest可识别出约70%有中度至重度纤维化组织学征象的患者和约90%有肝硬化组织学征象的患者。它能可靠地诊断或排除中度纤维化，并诊断肝硬化。在排除肝硬化方面也非常可靠。Hepascore具有相似的诊断性能。FibroMeter的评估范围较小，但似乎也具有与FibroTest相似的诊断性能。一些研究表明，FibroTest在除慢性丙型肝炎之外的其他肝纤维化形式中具有相似的准确性。在实践中，慢性丙型肝炎患者治疗决策中涉及的主要问题是现有治疗方法的风险效益平衡，而非纤维化的精确诊断。
