Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Zeppelinstraße 11-33, 69121 Heidelberg, Germany.
J Hepatol. 2019 Feb;70(2):273-283. doi: 10.1016/j.jhep.2018.11.025.
Even though alcohol-related liver disease (ALD) is a major cause of severe liver disease worldwide, most patients with ALD are diagnosed at the decompensation stage. Liver biopsy is still considered the gold standard for establishing a definite diagnosis and assessing the fibrosis stage of ALD, but it is an invasive procedure, associated with significant morbidity. During the last decade, non-invasive tests have been developed to estimate the severity of liver fibrosis and steatosis. Measurement of liver stiffness by transient elastography has become the most commonly used non-invasive parameter to evaluate fibrosis. In ALD, transient elastography has been demonstrated to have an excellent performance to detect advanced fibrosis and cirrhosis. However, aspartate aminotransferase levels must be considered when interpreting liver stiffness cut-offs. Non-invasive biological tests have also been evaluated to assess liver fibrosis in ALD. The commercially available Enhanced Liver Fibrosis test and FibroTest have comparable performance for the diagnosis of advanced fibrosis in ALD, with studies suggesting that they are better than other biological tests (i.e. FIB-4 and APRI). Although ultrasound is still accepted as an initial screen for fatty liver diagnosis, new methods have recently been developed to detect steatosis. Magnetic resonance spectroscopy and magnetic resonance imaging techniques are highly accurate and reproducible, with superior sensitivities and specificities for detecting histological steatosis than ultrasound. However, low availability and high cost limit the use of magnetic resonance techniques in routine clinical practice. More recently, controlled attenuation parameter was developed as a novel tool to non-invasively assess liver steatosis; performed in combination with transient elastography, it was suggested to be superior to regular ultrasound for detecting steatosis and was shown to have acceptable diagnostic accuracy. New serum biomarkers are under investigation to non-invasively diagnose more severe forms of ALD and to predict prognosis of patients.
尽管酒精性肝病（ALD）是全球严重肝脏疾病的主要病因，但大多数 ALD 患者在失代偿期才被诊断出来。肝活检仍然被认为是确定诊断和评估 ALD 纤维化分期的金标准，但它是一种有创性操作，会引起显著的发病率。在过去的十年中，已经开发出了非侵入性检测方法来评估肝纤维化和脂肪变性的严重程度。瞬时弹性成像测量肝硬度已成为评估纤维化的最常用非侵入性参数。在 ALD 中，瞬时弹性成像已被证明具有出色的性能，可以检测出晚期纤维化和肝硬化。然而，在解释肝硬度切点时必须考虑天门冬氨酸氨基转移酶水平。非侵入性生物检测也已被评估用于评估 ALD 中的肝纤维化。商业上可用的增强型肝脏纤维化检测和 FibroTest 在诊断 ALD 中的晚期纤维化方面具有相当的性能，研究表明它们优于其他生物检测（即 FIB-4 和 APRI）。尽管超声检查仍然被接受为脂肪肝诊断的初步筛查，但最近已经开发出了新的方法来检测脂肪变性。磁共振光谱和磁共振成像技术具有高度的准确性和可重复性，在检测组织学脂肪变性方面比超声检查具有更高的敏感性和特异性。然而，低可用性和高成本限制了磁共振技术在常规临床实践中的应用。最近，控制衰减参数被开发为一种新的工具，用于非侵入性评估肝脂肪变性；与瞬时弹性成像联合使用时，被认为比常规超声更能检测脂肪变性，并且具有可接受的诊断准确性。正在研究新的血清生物标志物，以非侵入性方式诊断更严重形式的 ALD 并预测患者的预后。
