Kumar Rahul, Teo Eng Kiong, How Choon How, Wong Teck Yee, Ang Tiing Leong
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Care and Health Integration, Changi General Hospital, Singapore.
Singapore Med J. 2018 Dec;59(12):628-633. doi: 10.11622/smedj.2018145.
Liver fibrosis is a slow, insidious process involving accumulation of extracellular matrix protein in the liver. The stage of liver fibrosis in chronic liver disease (CLD) determines overall morbidity and mortality; the higher the stage, the worse the prognosis. Noninvasive composite scores can be used to determine whether patients with CLD have significant or advanced fibrosis. Patients with low composite scores can be safely followed up in primary care with periodic reassessment. Those with higher scores should be referred to a specialist. As the epidemic of diabetes mellitus, obesity and non-alcoholic fatty liver diseases is rising, CLD is becoming more prevalent. Easy-to-use fibrosis assessment composite scores can identify patients with minimal or advanced fibrosis, and should be an integral part of decision-making. Patients with cirrhosis, high composite scores, chronic hepatitis B with elevated alanine aminotransferase and aspartate aminotransferase, or deranged liver panel of uncertain aetiology should be referred to a specialist.
肝纤维化是一个缓慢、隐匿的过程，涉及肝脏细胞外基质蛋白的积累。慢性肝病（CLD）中的肝纤维化阶段决定了总体发病率和死亡率；阶段越高，预后越差。非侵入性综合评分可用于确定CLD患者是否存在显著或晚期纤维化。综合评分低的患者可在初级保健中进行安全随访，并定期重新评估。评分较高的患者应转诊至专科医生处。随着糖尿病、肥胖症和非酒精性脂肪性肝病的流行率上升，CLD正变得越来越普遍。易于使用的纤维化评估综合评分可以识别轻度或晚期纤维化患者，应成为决策的一个组成部分。患有肝硬化、综合评分高、丙氨酸氨基转移酶和天冬氨酸氨基转移酶升高的慢性乙型肝炎或病因不明的肝功能检查异常的患者应转诊至专科医生处。
