肝纤维化的治疗:过去、现在与未来

Treatment of liver fibrosis: Past, current, and future.

作者信息

Zhang Chun-Ye, Liu Shuai, Yang Ming

机构信息

Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, United States.

Department of Radiology,The First Affiliated Hospital, Zhejiang University, Hangzhou 310006, Zhejiang Province, China.

出版信息

World J Hepatol. 2023 Jun 27;15(6):755-774. doi: 10.4254/wjh.v15.i6.755.

Abstract

Liver fibrosis accompanies the progression of chronic liver diseases independent of etiologies, such as hepatitis viral infection, alcohol consumption, and metabolic-associated fatty liver disease. It is commonly associated with liver injury, inflammation, and cell death. Liver fibrosis is characterized by abnormal accumulation of extracellular matrix components that are expressed by liver myofibroblasts such as collagens and alpha-smooth actin proteins. Activated hepatic stellate cells contribute to the major population of myofibroblasts. Many treatments for liver fibrosis have been investigated in clinical trials, including dietary supplementation (, vitamin C), biological treatment (, simtuzumab), drug (, pegbelfermin and natural herbs), genetic regulation (, non-coding RNAs), and transplantation of stem cells (, hematopoietic stem cells). However, none of these treatments has been approved by Food and Drug Administration. The treatment efficacy can be evaluated by histological staining methods, imaging methods, and serum biomarkers, as well as fibrosis scoring systems, such as fibrosis-4 index, aspartate aminotransferase to platelet ratio, and non-alcoholic fatty liver disease fibrosis score. Furthermore, the reverse of liver fibrosis is slowly and frequently impossible for advanced fibrosis or cirrhosis. To avoid the life-threatening stage of liver fibrosis, anti-fibrotic treatments, especially for combined behavior prevention, biological treatment, drugs or herb medicines, and dietary regulation are needed. This review summarizes the past studies and current and future treatments for liver fibrosis.

摘要

肝纤维化伴随着慢性肝病的进展,与病因无关,如病毒性肝炎感染、饮酒和代谢相关脂肪性肝病。它通常与肝损伤、炎症和细胞死亡有关。肝纤维化的特征是细胞外基质成分异常积累,这些成分由肝肌成纤维细胞表达,如胶原蛋白和α-平滑肌肌动蛋白。活化的肝星状细胞是肌成纤维细胞的主要来源。许多肝纤维化治疗方法已在临床试验中进行了研究,包括膳食补充剂(如维生素C)、生物治疗(如西马珠单抗)、药物(如聚乙二醇化重组人胰岛素样生长因子-1和天然草药)、基因调控(如非编码RNA)以及干细胞移植(如造血干细胞)。然而,这些治疗方法均未获得美国食品药品监督管理局的批准。治疗效果可通过组织学染色方法、成像方法、血清生物标志物以及纤维化评分系统进行评估,如纤维化-4指数、天冬氨酸转氨酶与血小板比值以及非酒精性脂肪性肝病纤维化评分。此外,肝纤维化的逆转缓慢,对于晚期纤维化或肝硬化通常是不可能的。为避免肝纤维化危及生命的阶段,需要抗纤维化治疗,特别是联合行为预防、生物治疗、药物或草药以及饮食调节。本综述总结了过去关于肝纤维化的研究以及当前和未来的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fcf3/10308286/49644855af26/WJH-15-755-g001.jpg

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