Alkhouri Naim, McCullough Arthur J
Dr. Alkhouri and Dr. McCullough are affiliated with the Department of Gastroenterology and Hepatology and the Digestive Disease Institute at The Cleveland Clinic in Cleveland, Ohio.
Gastroenterol Hepatol (N Y). 2012 Oct;8(10):661-8.
Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in the United States, affecting an estimated 70 million Americans. The histologic spectrum of NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and eventually cirrhosis. Patients with NASH and significant fibrosis seen on liver biopsy have an increased risk for liver-related morbidity and mortality compared to patients with simple steatosis. Due to the high prevalence of NAFLD, there has been an urgent need to develop reliable noninvasive markers and tests that can accurately predict the presence of advanced disease without the need for liver biopsy. These tests can be divided into 2 groups: those that predict the presence of NASH (such as markers of hepatocyte apoptosis, oxidative stress, and inflammation, as well as predictive models based on clinical variables) and those that predict the presence of fibrosis (such as simple and complex predictive models). This paper provides an overview of various noninvasive methods for detecting NAFLD and suggests a diagnostic algorithm that can be used in clinical practice.
非酒精性脂肪性肝病（NAFLD）是美国最常见的慢性肝病类型，估计影响7000万美国人。NAFLD的组织学谱范围从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）、纤维化，最终发展为肝硬化。与单纯性脂肪变性患者相比，肝活检显示有NASH和显著纤维化的患者发生肝脏相关发病和死亡的风险增加。由于NAFLD的高患病率，迫切需要开发可靠的非侵入性标志物和检测方法，能够在无需肝活检的情况下准确预测晚期疾病的存在。这些检测方法可分为两类：一类预测NASH的存在（如肝细胞凋亡、氧化应激和炎症标志物，以及基于临床变量的预测模型），另一类预测纤维化的存在（如简单和复杂的预测模型）。本文概述了检测NAFLD的各种非侵入性方法，并提出了一种可用于临床实践的诊断算法。
