Service d'Hépatologie, Hôpital Beaujon, AP-HP, Université Denis Diderot Paris-VII, Clichy, France,
Hepatol Int. 2011 Jun;5(2):625-34. doi: 10.1007/s12072-010-9240-0. Epub 2011 Jan 20.
Quantification of hepatic fibrosis is of critical importance in chronic hepatitis C not only for prognosis, but also for antiviral treatment indication. Two end points are clinically relevant: detection of significant fibrosis (indication for antiviral treatment) and detection of cirrhosis (screening for eosphageal varices and hepatocellular carcinoma). Until recently, liver biopsy was considered the reference method for the evaluation of liver fibrosis. Limitations of liver biopsy (invasiveness, sampling error, and inter-observer variability) have led to the development of non-invasive methods. Currently available methods rely on two different approaches: a "biological" approach based on the dosage of serum fibrosis biomarkers; and a "physical" approach based on the measurement of liver stiffness, using transient elastography (TE). This review is aimed at discussing the advantages and limits of non-invasive methods and liver biopsy and the perspectives for their rational use in clinical practice in the management of patients with chronic hepatitis C.
肝纤维化的定量评估对慢性丙型肝炎至关重要，不仅对预后有影响，而且对抗病毒治疗的适应证也有影响。有两个临床相关的终点：检测显著的纤维化（抗病毒治疗的适应证）和检测肝硬化（筛查食管静脉曲张和肝细胞癌）。直到最近，肝活检一直被认为是评估肝纤维化的参考方法。肝活检的局限性（侵袭性、取样误差和观察者间的变异性）导致了非侵入性方法的发展。目前可用的方法依赖于两种不同的方法：一种是基于血清纤维化生物标志物剂量的“生物学”方法；另一种是基于使用瞬时弹性成像（TE）测量肝硬度的“物理”方法。这篇综述旨在讨论非侵入性方法和肝活检的优缺点以及在慢性丙型肝炎患者管理中合理使用这些方法的前景。
