Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
World J Gastroenterol. 2020 Oct 21;26(39):5919-5943. doi: 10.3748/wjg.v26.i39.5919.
Non-alcoholic fatty liver disease (NAFLD) is among the most frequent etiologies of cirrhosis worldwide, and it is associated with features of metabolic syndrome; the key factor influencing its prognosis is the progression of liver fibrosis. This review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD, analyzing the currently available literature. In the assessment of NAFLD patients, it is important to identify clinical, genetic, and environmental determinants of fibrosis development and its progression. To properly detect fibrosis, it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores, followed by a complementary imaging study (transient elastography, magnetic resonance elastography or acoustic radiation force impulse) and finally a liver biopsy, when needed. To help with the selection of the most appropriate method a Fagan's nomogram analysis is provided in this review, describing the diagnostic yield of each method and their post-test probability of detecting liver fibrosis. Finally, treatment should always include diet and exercise, as well as controlling the components of the metabolic syndrome, +/- vitamin E, considering the presence of sleep apnea, and when available, allocate those patients with advanced fibrosis or high risk of progression into clinical trials. The final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD, aiming to decrease/stop its progression and improve their prognosis.
非酒精性脂肪性肝病 (NAFLD) 是全球最常见的肝硬化病因之一，与代谢综合征的特征有关；影响其预后的关键因素是肝纤维化的进展。本综述旨在针对 NAFLD 患者的肝纤维化评估和管理提出一种实用的、逐步的方法，分析目前可用的文献。在评估 NAFLD 患者时，重要的是要确定纤维化发展及其进展的临床、遗传和环境决定因素。为了正确检测纤维化，重要的是要考虑到现有的方法及其支持的科学证据，以指导方法的选择和最佳生化评分的顺序选择，然后是补充成像研究（瞬时弹性成像、磁共振弹性成像或声辐射力脉冲），最后在需要时进行肝活检。为了帮助选择最合适的方法，本综述提供了 Fagan 的列线图分析，描述了每种方法的诊断效果及其检测肝纤维化的后验概率。最后，治疗应始终包括饮食和运动，以及控制代谢综合征的成分， +/- 维生素 E，考虑是否存在睡眠呼吸暂停，并在可用时，将那些患有晚期纤维化或进展高风险的患者分配到临床试验中。该方法的最终目的是在 NAFLD 患者中及时诊断和治疗肝纤维化，以减少/阻止其进展并改善其预后。
