Constantinescu CodruŢa, SĂndulescu Larisa, SĂftoiu Adrian
Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania.
Curr Health Sci J. 2020 Jul-Sep;46(3):255-269. doi: 10.12865/CHSJ.46.03.07. Epub 2020 Sep 30.
The most common liver disease in developing countries is non-alcoholic fatty liver disease (NAFLD). This involves the abnormal accumulation of lipids in the liver, the pathogenesis of the disease being related to dyslipidemia, obesity, insulin resistance and type 2 diabetes. Most often, the diagnosis of NAFLD is incidental, when performing routine blood tests or when performing a transabdominal ultrasound. The NAFLD spectrum ranges from simple forms of hepatic steatosis to the most advanced form of the disease, steatohepatitis (NASH), which in evolution can cause inflammation, fibrosis, cirrhosis of the liver and even liver cancer. For the evaluation of the prognosis and the clinical evolution, the most important parameter to define is the degree of liver fibrosis. Currently, the gold standard remains the liver biopsy, the differentiation between NAFLD and NASH being made only on the basis of histological analysis. However, liver biopsy is an invasive procedure, with numerous risks such as bleeding, lesions of the other organs and complications related to anesthesia, which significantly reduces its widespread use. Moreover, the risk of a false negative result and the increased costs of the procedure further limits its use in current practice. For this reason, non-invasive methods of evaluating the degree of liver fibrosis have gained ground in recent years. Imaging techniques such as elastography have shown promising results in evaluating and staging NAFLD. The aim of this article is to review the current status of the non-invasive tests for the assessment of NAFLD with a focus on the ultrasound-based elastography techniques.
发展中国家最常见的肝脏疾病是非酒精性脂肪性肝病（NAFLD）。这涉及肝脏中脂质的异常蓄积，该疾病的发病机制与血脂异常、肥胖、胰岛素抵抗和2型糖尿病有关。NAFLD的诊断大多是在进行常规血液检查或经腹部超声检查时偶然发现的。NAFLD的范围从简单的肝脂肪变性形式到该疾病最严重的形式——脂肪性肝炎（NASH），NASH在病情发展过程中可导致炎症、纤维化、肝硬化甚至肝癌。为了评估预后和临床进展，最重要的定义参数是肝纤维化程度。目前，金标准仍然是肝活检，NAFLD和NASH的区分仅基于组织学分析。然而，肝活检是一种侵入性操作，存在诸多风险，如出血、其他器官损伤以及与麻醉相关的并发症，这显著减少了其广泛应用。此外，假阴性结果的风险以及该操作成本的增加进一步限制了其在当前实践中的使用。因此，近年来评估肝纤维化程度的非侵入性方法得到了广泛应用。诸如弹性成像等成像技术在评估NAFLD及其分期方面已显示出有前景的结果。本文的目的是综述评估NAFLD的非侵入性检测的现状，重点关注基于超声的弹性成像技术。
