Departamento de Gastroenterología, Escuela de Medicina. Pontificia Universidad Católica de Chile, Santiago, Chile.
Ann Hepatol. 2018 Oct 16;17(6):899-902. doi: 10.5604/01.3001.0012.7188.
Evaluation patients with nonalcoholic steatohepatitis (NASH) imply the need of appropriate assessment of disease severity (i.e. the presence of nonalcoholic steatohepatitis (NASH)) as well as of the disease stage (i.e. the extent of liver fibrosis). Liver biopsy (LB) is still considered the gold standard for diagnosing NASH as well as for establishing the degree of liver fibrosis. However, due to its invasive nature and costs, use of LB should be restricted to selected patients and, according guidelines and expert opinion, indicated in the following scenarios: a) when LB will guide treatment, b) to confirm or exclude NAFLD in patients with conflicting clinical data, c) to increase patient's awareness about their disease, and improve engagement in their care and d) for inclusion in clinical trials. However, the role fo LB in NAFLD is evolving since when new and costly therapeutic agents become available, LB will be eventually necessary to make clinical decisions. The use of non-invasive tools (NITs) to assess steatosis, NASH and hepatic fibrosis is useful to triage NAFLD patients and decide in whom perform a LB.
评估非酒精性脂肪性肝炎（NASH）患者需要对疾病严重程度（即非酒精性脂肪性肝炎（NASH）的存在）以及疾病阶段（即肝纤维化程度）进行适当评估。肝活检（LB）仍然被认为是诊断 NASH 以及确定肝纤维化程度的金标准。然而，由于其侵袭性和成本，LB 的使用应限于选定的患者，并根据指南和专家意见，在以下情况下使用：a）当 LB 将指导治疗时，b）在临床数据有冲突的情况下，确认或排除非酒精性脂肪性肝病，c）提高患者对自身疾病的认识，并改善其对治疗的参与度，d）用于临床试验。然而，由于新的、昂贵的治疗药物的出现，LB 在非酒精性脂肪性肝病中的作用正在发生变化，因为最终需要 LB 来做出临床决策。使用非侵入性工具（NITs）来评估脂肪变性、NASH 和肝纤维化有助于对非酒精性脂肪性肝病患者进行分类，并决定对哪些患者进行 LB。
