NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
Lancet Gastroenterol Hepatol. 2017 Apr;2(4):288-297. doi: 10.1016/S2468-1253(16)30205-9. Epub 2017 Feb 1.
As of 2016, there is no evidence-based pathway to stratify the risk of chronic liver disease in a general population setting. Non-invasive tests of liver fibrosis might provide a mechanism for earlier diagnosis. These tests have been extensively validated in the hospital setting but their performance in a general population setting is unclear. We did a systematic review of non-invasive tests used to stratify patients at risk of clinically significant liver disease in a general population setting and report the prevalence of chronic liver disease as defined by these tests. We systematically searched Embase, MEDLINE, Web of Science, reference lists from the original studies identified, and recent conference proceedings. All study designs were considered. 19 studies were identified, in which 11 non-invasive tests were used. Only transient elastography and FibroTest were compared with histological endpoints. The prevalence of liver fibrosis varied between 0·7% and 25·7%. More focused stratification for advanced liver fibrosis (0·9-2·0%) or cirrhosis (0·1-1·7%) narrowed the estimates of prevalence. Investigators from studies targeting patients with risk factors of liver disease, such as non-alcoholic fatty liver disease, hazardous alcohol use, or type 2 diabetes, reported higher prevalence of advanced liver fibrosis (0-27·9%) and cirrhosis (2·4-4·0%) than those in the general population. Validated non-invasive tests for liver fibrosis consistently detected otherwise unrecognised liver disease in the general population. Reliance on abnormal liver function tests will miss most patients with significant liver injury. New pathways to stratify chronic liver disease, with the use of non-invasive markers of liver fibrosis, are needed in the general population setting.
截至 2016 年，尚无循证方法可对一般人群中的慢性肝病风险进行分层。肝脏纤维化的非侵入性检测可能为早期诊断提供一种机制。这些检测方法已在医院环境中得到广泛验证，但在一般人群环境中的性能尚不清楚。我们对用于在一般人群中分层具有临床显著肝病风险的患者的非侵入性检测进行了系统评价，并报告了这些检测方法所定义的慢性肝病的患病率。我们系统地搜索了 Embase、MEDLINE、Web of Science、从最初确定的研究中获取的参考文献列表以及最近的会议记录。考虑了所有研究设计。共确定了 19 项研究，其中使用了 11 种非侵入性检测方法。只有瞬时弹性成像和 FibroTest 与组织学终点进行了比较。肝脏纤维化的患病率在 0.7%至 25.7%之间有所不同。更集中地对晚期肝纤维化（0.9-2.0%）或肝硬化（0.1-1.7%）进行分层，缩小了患病率的估计范围。针对非酒精性脂肪性肝病、危险饮酒或 2 型糖尿病等肝病危险因素患者的研究的调查人员报告称，晚期肝纤维化（0-27.9%）和肝硬化（2.4-4.0%）的患病率高于一般人群。经过验证的肝脏纤维化非侵入性检测方法在一般人群中一致检测到其他未被识别的肝脏疾病。依赖异常的肝功能检测将使大多数具有显著肝损伤的患者漏诊。在一般人群中，需要使用肝脏纤维化的非侵入性标志物来确定慢性肝病的新分层途径。
