Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Expert Rev Mol Diagn. 2023 Jul-Dec;23(9):771-782. doi: 10.1080/14737159.2023.2242779. Epub 2023 Aug 1.
The non-invasive identification of liver fibrosis related to Non-Alcoholic Fatty Liver Disease is crucial for risk-stratification of patients. Currently, the reference standard to stage hepatic fibrosis relies on liver biopsy, but multiple approaches are developed to allow for non-invasive diagnosis and risk stratification. Non-invasive tests, including blood-based scores and vibration-controlled transient elastography, have been widely validated and represent a good surrogate for risk stratification according to recent European and American guidelines.
Novel approaches are based on 'liquid' biomarkers of liver fibrogenesis, including collagen-derived markers (PRO-C3 or PRO-C6), or 'multi-omics' technologies (e.g. proteomic-based molecules or miRNA testing), bearing the advantage of tailoring the intrahepatic disease activity. Alternative approaches are based on 'dry' biomarkers, including magnetic resonance-based tools (including proton density fat fraction, magnetic resonance elastography, or corrected T1), which reach similar accuracy of liver histology and will potentially help identify the best candidates for pharmacological treatment of fibrosing non-alcoholic steatohepatitis.
In the near future, the sequential use of non-invasive tests, as well as the complimentary use of liquid and dry biomarkers according to the clinical need (diagnosis, risk stratification, and prognosis, or treatment response) will guide and improve the management of this liver disease.
非酒精性脂肪性肝病相关肝纤维化的无创识别对患者风险分层至关重要。目前，肝纤维化分期的参考标准依赖于肝活检，但已开发出多种方法来进行非侵入性诊断和风险分层。包括基于血液的评分和振动控制瞬时弹性成像在内的非侵入性检测已得到广泛验证，并根据最近的欧洲和美国指南代表了风险分层的良好替代方法。
新方法基于肝纤维化形成的“液体”生物标志物，包括胶原衍生标志物（PRO-C3 或 PRO-C6）或“多组学”技术（例如基于蛋白质组学的分子或 miRNA 检测），具有针对肝内疾病活动进行定制的优势。替代方法基于“干燥”生物标志物，包括基于磁共振的工具（包括质子密度脂肪分数、磁共振弹性成像或校正 T1），这些方法达到了与肝组织学相似的准确性，并可能有助于确定纤维化非酒精性脂肪性肝炎药物治疗的最佳候选者。
在不久的将来，非侵入性检测的序贯使用，以及根据临床需求（诊断、风险分层和预后或治疗反应）互补使用液体和干燥生物标志物，将指导和改善这种肝病的管理。
