Righetti Riccardo, Cinque Felice, Patel Keyur, Sebastiani Giada
Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada.
Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada.
Expert Rev Gastroenterol Hepatol. 2025 Jan;19(1):65-80. doi: 10.1080/17474124.2025.2450717. Epub 2025 Jan 9.
INTRODUCTION: Accurate and reliable diagnosis and monitoring of hepatic fibrosis is increasingly important given the variable natural history in chronic liver disease (CLD) and expanding antifibrotic therapeutic options targeting reversibility of early-stage cirrhosis. This highlights the need to develop more refined and effective noninvasive techniques for the dynamic assessment of fibrogenesis and fibrolysis. AREAS COVERED: We conducted a literature review on PubMed, from 1 December 1970, to 1 November 2024, to evaluate and compare available blood-based and imaging-based noninvasive tools for hepatic fibrosis diagnosis and monitoring. Simple scores such as FIB-4 and NAFLD fibrosis score are suitable for excluding significant or advanced fibrosis, while tertiary centers should adopt complex scores and liver stiffness measurement as part of a secondary diagnostic and more comprehensive evaluation. Moreover, the advent of multiomics for high-resolution molecular profiling, and integration of artificial intelligence for noninvasive diagnostics holds promise for revolutionizing fibrosis monitoring and treatment through novel biomarker discovery and predictive omics-based algorithms. EXPERT OPINION: The increased shift toward noninvasive diagnostics for liver fibrosis needs to align with personalized medicine, enabling more effective, tailored management strategies for patients with liver disease in the future.
引言:鉴于慢性肝病(CLD)的自然病程各异,且针对早期肝硬化可逆性的抗纤维化治疗选择不断增加,准确可靠地诊断和监测肝纤维化变得越来越重要。这凸显了开发更精细、有效的非侵入性技术以动态评估纤维生成和纤维溶解的必要性。 涵盖领域:我们在PubMed上进行了文献综述,时间跨度为1970年12月1日至2024年11月1日,以评估和比较现有的基于血液和基于影像的非侵入性工具在肝纤维化诊断和监测中的应用。诸如FIB-4和非酒精性脂肪性肝病纤维化评分等简单评分适用于排除显著或晚期纤维化,而三级中心应采用复杂评分和肝脏硬度测量作为二级诊断和更全面评估的一部分。此外,多组学用于高分辨率分子谱分析以及人工智能用于非侵入性诊断的出现,有望通过发现新的生物标志物和基于预测组学的算法,彻底改变纤维化的监测和治疗。 专家意见:向肝纤维化非侵入性诊断的转变增加,需要与个性化医疗相结合,以便在未来为肝病患者制定更有效、个性化的管理策略。
Expert Rev Gastroenterol Hepatol. 2025-1
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