aDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA bLiver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Curr Opin Gastroenterol. 2014 May;30(3):253-9. doi: 10.1097/MOG.0000000000000059.
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. Most of these markers have been developed in chronic hepatitis C (CHC) and nonalcoholic fatty liver disease (NAFLD) patients. This review highlights some of the recent advances and potential clinical application of these modalities.
Many noninvasive approaches initially developed for binary disease staging in CHC continue to be refined for diagnostic use in other chronic liver disease such as NAFLD. A combination of serum markers and imaging tools appears useful in reducing the need for biopsy for the diagnosis of cirrhosis, and providing functional assessment in advanced stage disease. Cytokeratin-18 fragments, controlled attenuation parameter (CAP), real-time elastography, and magnetic resonance imaging approaches appear promising for NAFLD, but require further validation.
Current noninvasive tests of fibrosis provide good diagnostic and prognostic utility for advanced stage liver disease, and have been adapted into clinical practice for CHC. Reliable biomarkers for steatosis, nonalcoholic steatohepatitis, and assessment of fibrosis progression in chronic liver disease are still required. Continued advances in bioimaging and functional genomics will be important for quantitative assessment of fibrosis and future biomarker development.
纤维化病理生理学认识的提高和最近技术的进步，促使人们开发了几种血清生物标志物和成像工具，作为活检的非侵入性替代方法。这些标志物大多数是在慢性丙型肝炎（CHC）和非酒精性脂肪性肝病（NAFLD）患者中开发的。这篇综述强调了这些方法的一些最新进展和潜在的临床应用。
最初为 CHC 进行的用于疾病分期的许多非侵入性方法，在用于其他慢性肝病（如 NAFLD）的诊断时，仍在不断完善。血清标志物和成像工具的组合似乎可用于减少对肝硬化诊断的活检需求，并对晚期疾病进行功能评估。细胞角蛋白 18 片段、受控衰减参数（CAP）、实时弹性成像和磁共振成像方法在 NAFLD 中似乎很有前景，但需要进一步验证。
目前纤维化的非侵入性检测方法对晚期肝病提供了良好的诊断和预后效用，并已适应 CHC 的临床实践。仍然需要可靠的肝脂肪变性、非酒精性脂肪性肝炎和慢性肝病纤维化进展评估的生物标志物。生物成像和功能基因组学的持续进步对于纤维化的定量评估和未来生物标志物的开发将非常重要。
