Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.
Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
J Gastroenterol Hepatol. 2024 Feb;39(2):245-255. doi: 10.1111/jgh.16432. Epub 2023 Dec 6.
Clinical manifestations of liver inflammation in alcohol-associated liver disease (ALD) can range from asymptomatic to severe alcoholic hepatitis. While biopsy is the gold standard for identifying liver inflammation, it is an invasive procedure with risks of bleeding, visceral damage, and infection. We aim to establish the state of the current literature on non-invasive markers of inflammation in ALD. We searched Ovid MEDLINE, Embase, and the Cochrane Library for original studies on the association between one or more non-invasive biomarker(s) and histological inflammation or hepatitis in ALD patients. Exclusion criteria were lack of histological data, abstract only, non-English-language articles, and animal studies. Two independent reviewers screened abstracts, reviewed full texts, and extracted data from included papers. Our search identified 8051 unique studies. Title and abstract screening resulted in 563 studies, and full-text screening resulted in 31 studies for final inclusion. The majority were single-center observational cohorts with an average sample size of 124. Review of these studies identified 44 unique biomarkers and 8 calculated scores associated with histological inflammation and/or hepatitis, in addition to a metabolomic panel of 468 metabolites. Six studies examined diagnostic accuracy for histological inflammation and/or hepatitis. The highest area under the receiver operating characteristic curve was 0.932 using a model based on four metabolites. This review highlights the available literature on non-invasive markers of inflammation in ALD. There is a dearth of studies that evaluate the diagnostic accuracy of these biomarkers, and larger studies are needed to confirm findings identified in small cohorts.
酒精性肝病（ALD）中肝脏炎症的临床表现范围从无症状到严重的酒精性肝炎不等。虽然活检是识别肝脏炎症的金标准，但它是一种具有出血、内脏损伤和感染风险的侵入性程序。我们旨在确定关于 ALD 中炎症非侵入性标志物的当前文献状况。我们在 Ovid MEDLINE、Embase 和 Cochrane 图书馆中搜索了关于一种或多种非侵入性生物标志物与 ALD 患者组织学炎症或肝炎之间关联的原始研究。排除标准为缺乏组织学数据、仅摘要、非英语文章和动物研究。两名独立审查员筛选摘要、审查全文并从纳入的论文中提取数据。我们的搜索确定了 8051 项独特的研究。标题和摘要筛选产生了 563 项研究，全文筛选产生了 31 项最终纳入的研究。这些研究大多数为单中心观察性队列，平均样本量为 124 例。对这些研究的审查确定了 44 种独特的生物标志物和 8 种与组织学炎症和/或肝炎相关的计算评分，以及 468 种代谢物的代谢组学面板。有 6 项研究检查了组织学炎症和/或肝炎的诊断准确性。使用基于四种代谢物的模型，最佳接收者操作特征曲线下面积为 0.932。本综述强调了关于 ALD 中炎症非侵入性标志物的现有文献。评估这些生物标志物诊断准确性的研究很少，需要更大的研究来证实小队列中发现的结果。
