Patel Keyur, Bedossa Pierre, Castera Laurent
Division of Gastroenterology, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Department of Pathology, Physiology and Imaging, Hôpital Beaujon, Clichy, France.
Semin Liver Dis. 2015 May;35(2):166-83. doi: 10.1055/s-0035-1550059. Epub 2015 May 14.
The diagnostic assessment of liver fibrosis, a major determinant of disease severity, is an important step in the management of patients with chronic liver diseases. Liver biopsy is still considered the gold standard for the assessment of necroinflammation and fibrosis; however, recent technical advances have resulted in the development of numerous serum biomarkers and imaging tools as noninvasive alternatives to biopsy. These tests include biological (serum biomarker algorithms), physical (imaging assessment of tissue stiffness), and physiological (breath test) methods. Accumulating evidence shows that noninvasive tests provide prognostic information of clinical relevance, which has led to their incorporation into clinical guidelines and everyday practice. Here, the authors review and compare invasive and noninvasive tests for the diagnosis of liver fibrosis. They discuss emerging functional genomic, microparticle, protein-profiling, and bioimaging tools, focusing on novel sensitive tools that are able to assess the dynamic nature of fibrogenesis, a key requirement for the assessment of the efficacy of antifibrotic compounds in the future.
肝纤维化是疾病严重程度的主要决定因素，对其进行诊断评估是慢性肝病患者管理中的重要一步。肝活检仍被视为评估坏死性炎症和纤维化的金标准；然而，最近的技术进步催生了众多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。这些检测包括生物学（血清生物标志物算法）、物理（组织硬度成像评估）和生理学（呼气试验）方法。越来越多的证据表明，非侵入性检测可提供具有临床相关性的预后信息，这促使它们被纳入临床指南和日常实践。在此，作者回顾并比较了用于诊断肝纤维化的侵入性和非侵入性检测。他们讨论了新兴的功能基因组学、微粒、蛋白质谱分析和生物成像工具，重点关注能够评估纤维化形成动态性质的新型敏感工具，这是未来评估抗纤维化化合物疗效的关键要求。
