Balakrishnan Maya, Loomba Rohit
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Department of Medicine, NAFLD Research Center.
J Clin Gastroenterol. 2020 Feb;54(2):107-113. doi: 10.1097/MCG.0000000000001284.
Assessing for the presence of non-alcoholic steatohepatitis (NASH) and the presence of advanced fibrosis is vital among patients with non-alcoholic fatty liver disease (NAFLD) as each is predictive of disease outcomes. A liver biopsy is the gold standard method for doing so but is impossible to perform among all patients with NAFLD. Reliable methods for noninvasively detecting for the presence of NASH and advanced fibrosis are thus a pressing need. The search for noninvasive tests has been more successful for advanced fibrosis than for NASH. Clinical prediction models and elastography have acceptable accuracy for ruling out advanced fibrosis; when used together, as in a fibrosis prediction algorithm presented in this review, it can avoid the need for liver biopsy among many patients with NAFLD. Several biomarkers for identifying the presence of NASH have been studied but none are sufficiently accurate or validated. Of those studied, the most promising include CK-18 fragments, lipodomic and metabolomics candidates, and magnetic resonance elastography with proton density fat fraction. However, none are ready for clinical use and ultimately large multicenter prospective cohort studies are needed to validate select novel biomarkers.
对于非酒精性脂肪性肝病（NAFLD）患者而言，评估是否存在非酒精性脂肪性肝炎（NASH）以及是否存在晚期肝纤维化至关重要，因为这两者均可预测疾病的转归。肝活检是进行此项评估的金标准方法，但不可能对所有NAFLD患者都进行肝活检。因此，迫切需要可靠的非侵入性方法来检测NASH和晚期肝纤维化的存在。在寻找非侵入性检测方法方面，针对晚期肝纤维化的研究比针对NASH的更为成功。临床预测模型和弹性成像在排除晚期肝纤维化方面具有可接受的准确性；如本综述中所介绍的纤维化预测算法那样将两者结合使用，可以避免许多NAFLD患者进行肝活检。已经对几种用于识别NASH存在的生物标志物进行了研究，但尚无一种具有足够的准确性或经过验证。在已研究的生物标志物中，最有前景的包括细胞角蛋白18片段、脂质组学和代谢组学候选物以及带有质子密度脂肪分数的磁共振弹性成像。然而，这些都尚未准备好用于临床，最终需要大型多中心前瞻性队列研究来验证选定的新型生物标志物。
