Bassal Tamara, Basheer Maamoun, Boulos Mariana, Assy Nimer
Internal Medicine Department, Galilee Medical Center, Nahariya 2210001, Israel.
Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
Metabolites. 2022 Nov 5;12(11):1073. doi: 10.3390/metabo12111073.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, with a continuously growing prevalence. The pathophysiology of the disease is complex and includes several mechanisms, with metabolic syndrome and insulin resistance playing a major role. It is crucial to diagnose NAFLD before it advances to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis, presented by its complications which include ascites, portal hypertension, bleeding varices and encephalopathy. Another important complication of NAFLD and cirrhosis is hepatocellular carcinoma (HCC), a cancer with increasing incidence and poor prognosis. Even with the growing prevalence of NAFLD, diagnosis via liver biopsies is unrealistic, considering the costs and complications. Noninvasive tests, including serum biomarkers and elastography, are cost-effective and convenient, thereby replacing liver biopsies in diagnosing and excluding liver fibrosis. However, currently, these noninvasive tests have several limitations, such as variability, inadequate accuracy and risk factors for error. The limitations and variability of these tests comet the investigator to propose combining them in diagnostic algorithms to produce more accurate tools. Identifying patients with significant fibrosis is important for targeted therapies to prevent disease progression. Effective screening using noninvasive tests can be crucial for patient risk stratification and early diagnosis.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病，其患病率持续上升。该疾病的病理生理学很复杂，包括多种机制，其中代谢综合征和胰岛素抵抗起主要作用。在NAFLD进展为非酒精性脂肪性肝炎（NASH）之前进行诊断至关重要，NASH可进展为肝硬化，并伴有腹水、门静脉高压、静脉曲张出血和肝性脑病等并发症。NAFLD和肝硬化的另一个重要并发症是肝细胞癌（HCC），这是一种发病率不断上升且预后不良的癌症。尽管NAFLD的患病率不断上升，但考虑到成本和并发症，通过肝活检进行诊断并不现实。包括血清生物标志物和弹性成像在内的非侵入性检查具有成本效益且方便，因此在诊断和排除肝纤维化方面取代了肝活检。然而，目前这些非侵入性检查存在一些局限性，如变异性、准确性不足和误差风险因素。这些检查的局限性和变异性促使研究人员提出在诊断算法中结合使用它们，以产生更准确的工具。识别有显著纤维化的患者对于预防疾病进展的靶向治疗很重要。使用非侵入性检查进行有效筛查对于患者风险分层和早期诊断可能至关重要。
