Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Denis Diderot Paris-7, 100 boulevard du General Leclerc, 92110 Clichy, France.
Best Pract Res Clin Gastroenterol. 2011 Apr;25(2):291-303. doi: 10.1016/j.bpg.2011.02.003.
Chronic liver diseases represent a major public health problem, accounting for significant morbidity and mortality worldwide. Their prognosis and management greatly depend on the amount and progression of liver fibrosis with the risk of developing cirrhosis. Liver biopsy, traditionally considered as the reference standard for staging of fibrosis, has been challenged over the past decade by the development of novel non invasive methodologies. These methods rely on two distinct but complementary approaches: i) a 'biological' approach based on the dosage of serum biomarkers of fibrosis; ii) a 'physical' approach based on the measurement of liver stiffness using transient elastography (TE). Non invasive methods have been initially studied and validated in chronic hepatitis C but are now increasingly used in other chronic liver diseases, resulting in a significant decrease in the need for liver biopsy. However, they will likely not completely abolish the need for liver biopsy and they should rather be employed as an integrated system with liver biopsy. This review is aimed at discussing the advantages and inconveniences of non invasive methods in comparison with liver biopsy for the management of patients with chronic liver diseases.
慢性肝脏疾病是一个主要的公共卫生问题，在全球范围内造成了大量的发病率和死亡率。其预后和管理主要取决于肝纤维化的程度和进展，以及发展为肝硬化的风险。肝活检一直以来被认为是纤维化分期的金标准，但在过去十年中，新型非侵入性方法的发展对其提出了挑战。这些方法依赖于两种截然不同但互补的方法：i）基于纤维化血清生物标志物剂量的“生物学”方法；ii）基于使用瞬时弹性成像（TE）测量肝硬度的“物理”方法。非侵入性方法最初在慢性丙型肝炎中进行了研究和验证，但现在越来越多地用于其他慢性肝脏疾病，从而大大减少了对肝活检的需求。然而，它们不太可能完全消除肝活检的需求，而应该与肝活检一起作为一个综合系统来应用。本文旨在讨论与肝活检相比，非侵入性方法在慢性肝脏疾病患者管理中的优势和不足。
