Tapper Elliot B, Afdhal Nezam H
Department of Medicine, Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2015 May;31(3):192-8. doi: 10.1097/MOG.0000000000000169.
Therapeutic advances for hepatitis C and the increasing prevalence on nonalcoholic fatty liver disease are reshaping the diagnostic approach to disease staging in clinical hepatology. Well tolerated, inexpensive and reliable alternatives to liver biopsy are a critical need for clinicians and patients alike.
Vibration-controlled transient elastography (VCTE, also known as 'transient elastography') is a robust, point-of-care tool for the noninvasive assessment of liver fibrosis. This tool efficiently prioritizes the treatment for patients with viral hepatitis at risk for advanced liver disease and identifies the subgroups with metabolic or cholestatic liver disease who are at the highest risk. Rather than staging fibrosis, VCTE provides an accurate risk estimate of advanced fibrosis. In addition, it is increasingly recognized that elastography can predict outcomes including hepatic decompensation and mortality. The ideal use of this tool is to perform it in conjunction with a serologic marker of fibrosis to confirm its findings.
When combined with serologic markers of fibrosis, VCTE allows the vast majority of patients to avoid a liver biopsy.
丙型肝炎治疗进展以及非酒精性脂肪性肝病患病率的上升正在重塑临床肝病学中疾病分期的诊断方法。对于临床医生和患者而言，迫切需要耐受性良好、价格低廉且可靠的肝活检替代方法。
振动控制瞬时弹性成像（VCTE，也称为“瞬时弹性成像”）是一种用于肝纤维化无创评估的强大的即时检测工具。该工具有效地为有晚期肝病风险的病毒性肝炎患者确定治疗优先级，并识别出代谢性或胆汁淤积性肝病中风险最高的亚组。VCTE并非对纤维化进行分期，而是提供晚期纤维化的准确风险估计。此外，越来越多的人认识到弹性成像可以预测包括肝失代偿和死亡率在内的预后。该工具的理想用法是与纤维化血清学标志物联合使用以确认其结果。
当与纤维化血清学标志物联合使用时，VCTE可使绝大多数患者避免进行肝活检。
