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非酒精性脂肪性肝病中肝纤维化的无创评估及其临床意义

Noninvasive assessment of liver fibrosis and its clinical significance in nonalcoholic fatty liver disease.

作者信息

Tamaki Nobuharu, Kurosaki Masayuki, Huang Daniel Q, Loomba Rohit

机构信息

NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California, USA.

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

出版信息

Hepatol Res. 2022 Jun;52(6):497-507. doi: 10.1111/hepr.13764. Epub 2022 Apr 12.

Abstract

Liver fibrosis is the most important prognostic factor in patients with nonalcoholic fatty liver disease (NAFLD). Several noninvasive markers for fibrosis, including blood-based markers and imaging based-markers have been developed. Indirect fibrosis markers (e.g., fibrosis-4 index and NAFLD fibrosis score) consist of standard laboratory data and clinical parameters. Given its availability and high negative predictive value for advanced fibrosis, these markers are suitable for screening at primary care. Blood-based fibrogenesis markers (enhanced liver fibrosis and N-terminal propeptide of type 3 collagen), ultrasound-based modalities (vibration-controlled transient elastography, point shear wave elastography [SWE], and two-dimensional SWE), and magnetic resonance elastography have high diagnostic accuracy for liver fibrosis and are suitable for diagnosing liver fibrosis at secondary care centers. Sequential use of these markers can increase diagnostic accuracy and reduce health care costs. Furthermore, combining noninvasive makers may assist in identifying candidates for pharmacological trials and reducing screening failure. Emerging data suggest that these noninvasive markers are associated with liver-related events (hepatocellular carcinoma and decompensation) and mortality. Furthermore, delta change in noninvasive markers over time is also associated with time-course change in fibrosis, liver-related event risk, and mortality risk. However, the association between liver fibrosis and cardiovascular disease (CVD) risk is still controversial. CVD risk may decrease in patients with decompensated liver disease and noninvasive markers may be useful for assessing CVD risk in these patients. Therefore, noninvasive markers may be utilized as measures of fibrosis as well as real-time prognostic tools, in place of liver biopsy.

摘要

肝纤维化是非酒精性脂肪性肝病(NAFLD)患者最重要的预后因素。目前已开发出多种用于纤维化的非侵入性标志物,包括基于血液的标志物和基于影像的标志物。间接纤维化标志物(如纤维化-4指数和NAFLD纤维化评分)由标准实验室数据和临床参数组成。鉴于其可用性以及对晚期纤维化具有较高的阴性预测价值,这些标志物适用于基层医疗筛查。基于血液的纤维生成标志物(增强肝纤维化和Ⅲ型前胶原氨基端前肽)、基于超声的检查方法(振动控制瞬时弹性成像、点剪切波弹性成像[SWE]和二维SWE)以及磁共振弹性成像对肝纤维化具有较高的诊断准确性,适用于二级医疗中心诊断肝纤维化。序贯使用这些标志物可提高诊断准确性并降低医疗成本。此外,联合使用非侵入性标志物可能有助于确定药物试验的候选对象并减少筛查失败。新出现的数据表明,这些非侵入性标志物与肝脏相关事件(肝细胞癌和失代偿)及死亡率相关。此外,非侵入性标志物随时间的变化差值也与纤维化的时间进程变化、肝脏相关事件风险及死亡风险相关。然而,肝纤维化与心血管疾病(CVD)风险之间的关联仍存在争议。失代偿性肝病患者的CVD风险可能降低,非侵入性标志物可能有助于评估这些患者的CVD风险。因此,非侵入性标志物可作为纤维化的测量指标以及实时预后工具,以取代肝活检。

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