Ismaiel Abdulrahman, Dumitrascu Dan L
2 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Med Pharm Rep. 2021 Nov;94(Suppl No 3):S34-S37. doi: 10.15386/mpr-2511. Epub 2021 Nov 29.
Hepatic steatosis with inflammation, inflated hepatocytes, and potential fibrosis defines non-alcoholic steatohepatitis (NASH), which can possibly lead to liver cirrhosis. Although liver biopsy is still the gold standard for diagnosing NASH, numerous non-invasive surrogate markers have been investigated to reduce the need for this invasive technique. In this review we present several currently assessed biomarkers, scores, and indexes in assessing NASH.
A search in the main medical literature databases was conducted. We searched for observational studies evaluating non-invasive markers, scores, and panels in predicting NASH.
Several proinflammatory markers, inflammation and apoptosis biomarkers, as well as complex models have been studied in predicting NASH. Proinflammatory markers include C-reactive protein, ferritin, tumor necrosis factor-α, interleukin-6, pentraxin-3, and neutrophil extracellular traps. Inflammation and apoptosis biomarkers include cytokineratin-18, adipocytokines, lipid oxidation panels, plasminogen activator inhibitor-1, and products of free radical-mediated oxidation of linoleic acid. Moreover, several studied complex models such as NashTest, NashTest-2, pairing CK18 fragments with other biomarkers such as ALT and the presence of MetS, the HAIR model, acNASH, NAFIC score, Visceral Adiposity Index have also been studied.
A variety of diagnostic panels have shown good predictive values for diagnosing NASH. Nevertheless, non-invasive surrogate markers are currently unable to replace liver biopsy. However, their clinical significance is mainly in triaging patients for liver biopsy, reducing the financial burden associated with the procedure.
伴有炎症、肝细胞肿大及潜在纤维化的肝脂肪变性定义为非酒精性脂肪性肝炎（NASH），其可能导致肝硬化。尽管肝活检仍是诊断NASH的金标准，但已对众多非侵入性替代标志物进行了研究，以减少对这种侵入性技术的需求。在本综述中，我们介绍了目前在评估NASH时所评估的几种生物标志物、评分和指数。
在主要医学文献数据库中进行了检索。我们搜索了评估非侵入性标志物、评分和指标预测NASH的观察性研究。
已经对几种促炎标志物、炎症和凋亡生物标志物以及复杂模型进行了预测NASH的研究。促炎标志物包括C反应蛋白、铁蛋白、肿瘤坏死因子-α、白细胞介素-6、五聚素-3和中性粒细胞胞外陷阱。炎症和凋亡生物标志物包括细胞角蛋白-18、脂肪细胞因子、脂质氧化指标、纤溶酶原激活物抑制剂-1以及亚油酸自由基介导氧化产物。此外，还研究了几种复杂模型，如NashTest、NashTest-2、将CK18片段与其他生物标志物（如ALT）及代谢综合征的存在情况配对、HAIR模型、acNASH、NAFIC评分、内脏脂肪指数。
多种诊断指标对NASH的诊断显示出良好的预测价值。然而，目前非侵入性替代标志物尚无法取代肝活检。不过，它们的临床意义主要在于对患者进行肝活检分流，减轻与该检查相关的经济负担。
