Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.
Université Paris Cité, UMR 1149 (CRI), INSERM, Paris, France.
Clin Mol Hepatol. 2023 Feb;29(Suppl):S196-S206. doi: 10.3350/cmh.2022.0431. Epub 2022 Dec 5.
Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide, and its burden is expected to increase due to the growing epidemic of obesity and diabetes. The key challenge among NAFLD patients is to identify those with advanced fibrosis (F3F4), who are at high risk of developing complications and will benefit from specialized management and treatment with new pharmacotherapies when they are approved. Liver biopsy appears unrealistic and unsuitable in practice, given the large number of high-risk patients and its well-known limitations. Non-invasive sequential algorithms using fibrosis-4 index as first-line test, followed by vibration-controlled transient elastography or patented blood test, are the best strategy for case finding of high-risk subjects. In fact, they are now recommended by several international guidelines, and should be used and disseminated to increase awareness among physicians beyond liver clinics where most NAFLD patients are seen.
非酒精性脂肪性肝病（NAFLD）正在成为全球最常见的肝脏疾病，由于肥胖和糖尿病的流行，其负担预计将会增加。NAFLD 患者的主要挑战是识别出患有晚期纤维化（F3F4）的患者，这些患者发生并发症的风险很高，并且在新的药物治疗获得批准后，将从专门的管理和治疗中获益。鉴于大量高危患者以及其众所周知的局限性，肝活检在实践中似乎不太现实且不合适。使用纤维化-4 指数作为一线检测的无创序贯算法，随后是振动控制瞬时弹性成像或专利血液检测，是发现高危患者的最佳策略。事实上，它们现在已被多个国际指南推荐，应该被使用和传播，以提高除了大多数 NAFLD 患者就诊的肝脏诊所之外的医生的意识。
