Liver Unit, Department of Medical Sciences, IRCCS Fondazione, "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
Cells. 2020 Apr 17;9(4):1005. doi: 10.3390/cells9041005.
The aim of this review is to outline emerging biomarkers that can serve as early diagnostic tools to identify patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) and, among them, the subgroup of best candidates for clinical trials on emerging compounds. Regarding possible predictors of NAFLD, a number of studies evaluated a combination of serum biomarkers either available in routine practice (or investigational) or proprietary and expensive. So far, magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) appears to be the most accurate for fatty liver diagnosis. In clinical practice, the main question is how to diagnose NASH early. There are new promising biomarkers that can help in diagnosing early stages of NASH, yet they include variables not routinely tested. In the setting of NASH, most studies confirm that, in spite of several well-known limitations, transient elastography or point shear wave elastography can help in enriching the pool of patients that should be screened for investigational treatments. Newer multiomics biomarkers including those focusing on microbiota can be useful but require methods to be standardized and implemented. To date, one biomarker alone is not able to non- or minimally invasively identify patients with NASH and mild to moderate fibrosis.
本文旨在概述新兴的生物标志物，这些标志物可作为早期诊断工具，用于识别非酒精性脂肪性肝病 (NAFLD) 和非酒精性脂肪性肝炎 (NASH) 患者，以及其中最适合新兴化合物临床试验的亚组患者。关于 NAFLD 的可能预测因素，有许多研究评估了组合的血清生物标志物，这些生物标志物在常规实践（或研究）中可用，或者是专有的、昂贵的。到目前为止，基于磁共振成像的质子密度脂肪分数（MRI-PDFF）似乎是最准确的脂肪肝诊断方法。在临床实践中，主要问题是如何早期诊断 NASH。有一些新的有前途的生物标志物可以帮助诊断 NASH 的早期阶段，但它们包括常规检测之外的变量。在 NASH 中，尽管存在一些众所周知的局限性，大多数研究证实瞬时弹性成像或点剪切波弹性成像可以帮助丰富应该接受研究性治疗筛查的患者群体。包括专注于微生物组的新型多组学生物标志物可能有用，但需要标准化和实施方法。迄今为止，单一生物标志物还不能非侵入性或微创地识别 NASH 患者和轻度至中度纤维化患者。
