Chow Kenneth W, Futela Pragyat, Saharan Aryan, Saab Sammy
Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
J Clin Exp Hepatol. 2023 Sep-Oct;13(5):783-793. doi: 10.1016/j.jceh.2023.01.016. Epub 2023 Feb 5.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. However, there is no clear consensus on optimal screening strategies and risk stratification. We conducted a systematic review of society guidelines to identify differences in recommendations regarding the screening, diagnosis, and assessment of NAFLD.
We searched PubMed, Web of Science, and Embase databases from January 1, 2015, to August 2, 2022. Two researchers independently extracted information from the guidelines about screening strategies, risk stratification, use of noninvasive tests (NITs) to assess hepatic fibrosis, and indications for liver biopsy.
Twenty clinical practice guidelines and consensus statements were identified in our search. No guidelines recommended routine screening for NAFLD, while 14 guidelines recommended case finding in high-risk groups. Of the simple risk stratification models to assess for fibrosis, the fibrosis-4 score was the most frequently recommended, followed by the NAFLD fibrosis score. However, guidelines differed on which cutoffs to use and the interpretation of "high-risk" results.
Multiple guidelines exist with varying recommendations on the benefits of screening and interpretation of NIT results. Despite their differences, all guidelines recognize the utility of NITs and recommend their incorporation into the clinical assessment of NAFLD.
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病最常见的病因。然而，对于最佳筛查策略和风险分层尚无明确共识。我们对社会指南进行了系统评价，以确定关于NAFLD筛查、诊断和评估建议的差异。
我们检索了2015年1月1日至2022年8月2日期间的PubMed、科学网和Embase数据库。两名研究人员独立从指南中提取有关筛查策略、风险分层、使用非侵入性检测（NITs）评估肝纤维化以及肝活检指征的信息。
在我们的检索中识别出20份临床实践指南和共识声明。没有指南推荐对NAFLD进行常规筛查，而14份指南推荐在高危人群中进行病例发现。在用于评估纤维化的简单风险分层模型中，纤维化-4评分是最常被推荐的，其次是NAFLD纤维化评分。然而，指南在使用何种临界值以及对“高危”结果的解读方面存在差异。
存在多个指南，对筛查益处和NIT结果解读的建议各不相同。尽管存在差异，但所有指南都认可NITs的效用，并建议将其纳入NAFLD的临床评估中。
