Department of Infectious Diseases, Nanjing Drum Tower Hospital, University Medical School, Nanjing, China.
Hepatology Unit, CHU Bordeaux, & BRIC, INSERM U1312, Bordeaux University, Bordeaux, France.
United European Gastroenterol J. 2024 Mar;12(2):219-225. doi: 10.1002/ueg2.12491. Epub 2023 Nov 21.
Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and eventually cirrhosis and hepatocellular carcinoma (HCC). The diagnosis of NAFLD is based on the detection of excess fat disposition in the liver, which is the first step to trigger further evaluation of NAFLD, including necroinflammation and fibrosis. In this review, we discuss non-invasive biomarkers and imaging tools that are currently and potentially available for different features (steatosis, necroinflammation and fibrosis) and disease severity assessment of NAFLD. In the past 2 decades, advances in non-invasive tests of fibrosis have transformed the management of NAFLD. Blood and imaging biomarkers have already been evaluated in multiple studies for the diagnosis of fibrosis and cirrhosis. Among the various histological features of NAFLD, the degree of fibrosis has the strongest correlation with liver-related morbidity and mortality. Non-invasive tests of fibrosis have been shown to predict liver-related outcomes, both in the general population and among patients with NAFLD. What is lacking, however, is good data to support the use of non-invasive tests as monitoring and response biomarkers. With the conclusion of several large phase 3 studies in the next few years, the availability of paired liver biopsy, non-invasive test and clinical outcome data will likely advance the field and shed light on new biomarkers and the way to use various non-invasive tests in a longitudinal manner.
非酒精性脂肪性肝病（NAFLD）包括单纯性脂肪变性、非酒精性脂肪性肝炎（NASH）、纤维化，最终发展为肝硬化和肝细胞癌（HCC）。NAFLD 的诊断基于肝脏内脂肪堆积的检测，这是触发进一步评估 NAFLD 的第一步，包括坏死性炎症和纤维化。在这篇综述中，我们讨论了目前和潜在可用于不同特征（脂肪变性、坏死性炎症和纤维化）和 NAFLD 严重程度评估的非侵入性生物标志物和成像工具。在过去的 20 年中，纤维化的非侵入性检测技术的进步改变了 NAFLD 的管理方式。血液和成像生物标志物已经在多项研究中被评估用于纤维化和肝硬化的诊断。在 NAFLD 的各种组织学特征中，纤维化程度与肝脏相关发病率和死亡率的相关性最强。非侵入性纤维化检测已被证明可预测肝脏相关结局，无论是在普通人群中还是在 NAFLD 患者中。然而，缺乏良好的数据来支持将非侵入性检测作为监测和反应生物标志物的使用。随着未来几年几项大型 3 期研究的结束，获得配对的肝活检、非侵入性检测和临床结局数据可能会推动该领域的发展，并为新的生物标志物以及以纵向方式使用各种非侵入性检测的方法提供启示。
