Golabi Pegah, Sayiner Mehmet, Fazel Yousef, Koenig Aaron, Henry Linda, Younossi Zobair M
a Betty and Guy Beatty Center for Integrated Research , Inova Health System , Falls Church , VA , USA.
b Center for Liver Disease, Department of Medicine , Inova Fairfax Hospital , Falls Church , VA , USA.
Expert Rev Gastroenterol Hepatol. 2016;10(1):63-71. doi: 10.1586/17474124.2016.1099433. Epub 2015 Oct 15.
Nonalcoholic steatohepatitis (NASH) can lead to complications such as liver failure, cirrhosis and hepatocellular carcinoma. The diagnostic gold standard for NASH is liver biopsy; however, other noninvasive methods have been developed. In this article, the authors evaluate current methods in NASH screening and diagnosis. Routine radiologic modalities were found to detect hepatic steatosis accurately, but were unable to establish the diagnosis of NASH or stage of fibrosis. Newly developed elastography based techniques seem promising to estimate liver fibrosis. Other noninvasive tests such as FibroTest, ELF, Hepascore, FIB-4, NFS, FLI and ION (biochemical panels) have AUROCs ranging between 0.80-0.98 for detecting advanced fibrosis but lack specificity for detecting mild fibrosis. Noninvasive tools, especially elastography, identify NASH associated advanced fibrosis potentially reducing liver biopsies. More research is needed to validate the clinical utility of these tests.
非酒精性脂肪性肝炎（NASH）可导致肝功能衰竭、肝硬化和肝细胞癌等并发症。NASH的诊断金标准是肝活检；然而，已经开发出了其他非侵入性方法。在本文中，作者评估了NASH筛查和诊断的当前方法。常规放射学检查方法能够准确检测肝脂肪变性，但无法确诊NASH或纤维化分期。新开发的基于弹性成像的技术在估计肝纤维化方面似乎很有前景。其他非侵入性检测方法，如FibroTest、ELF、Hepascore、FIB-4、NFS、FLI和ION（生化指标），检测晚期纤维化的曲线下面积（AUROC）在0.80-0.98之间，但检测轻度纤维化缺乏特异性。非侵入性工具，尤其是弹性成像，可识别与NASH相关的晚期纤维化，有可能减少肝活检。需要更多的研究来验证这些检测方法的临床实用性。
