Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan.
Division of Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Int J Mol Sci. 2020 Jul 11;21(14):4906. doi: 10.3390/ijms21144906.
Liver fibrosis is one of the risk factors for hepatocellular carcinoma (HCC) development. The staging of liver fibrosis can be evaluated only via a liver biopsy, which is an invasive procedure. Noninvasive methods for the diagnosis of liver fibrosis can be divided into morphological tests such as elastography and serum biochemical tests. Transient elastography is reported to have excellent performance in the diagnosis of liver fibrosis and has been accepted as a useful tool for the prediction of HCC development and other clinical outcomes. Two-dimensional shear wave elastography is a new technique and provides a real-time stiffness image. Serum fibrosis markers have been studied based on the mechanism of fibrogenesis and fibrolysis. In the healthy liver, homeostasis of the extracellular matrix is maintained directly by enzymes called matrix metalloproteinases (MMPs) and their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs). MMPs and TIMPs could be useful serum biomarkers for liver fibrosis and promising candidates for the treatment of liver fibrosis. Further studies are required to establish liver fibrosis-specific markers based on further clinical and molecular research. In this review, we summarize noninvasive fibrosis tests and molecular mechanism of liver fibrosis in current daily clinical practice.
肝纤维化是肝细胞癌（HCC）发展的风险因素之一。肝纤维化的分期只能通过肝活检来评估，而肝活检是一种有创的操作。用于诊断肝纤维化的非侵入性方法可分为形态学检查，如弹性成像和血清生化检查。瞬时弹性成像在肝纤维化的诊断中具有出色的性能，已被认为是预测 HCC 发展和其他临床结局的有用工具。二维剪切波弹性成像是一种新技术，可提供实时的硬度图像。基于纤维化和纤溶的机制，已经研究了血清纤维化标志物。在健康的肝脏中，细胞外基质的动态平衡由称为基质金属蛋白酶（MMPs）及其特定抑制剂，金属蛋白酶组织抑制剂（TIMPs）的酶直接维持。MMPs 和 TIMPs 可能是肝纤维化的有用血清生物标志物，也是肝纤维化治疗的有前途的候选者。需要进一步的研究来基于进一步的临床和分子研究建立基于肝纤维化的特异性标志物。在这篇综述中，我们总结了目前日常临床实践中的非侵入性纤维化检查和肝纤维化的分子机制。
