Kalligeros Markos, Danpanichkul Pojsakorn, Noureddin Mazen
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Gastroenterol Hepatol (N Y). 2024 Nov;20(11):672-677.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty liver disease, is a major global health issue and a leading cause of chronic liver disease. The prevalence of MASLD is increasing globally, with the disease in some patients progressing to metabolic dysfunction-associated steatohepatitis (MASH), which significantly raises the risk of fibrosis, cirrhosis, and adverse outcomes. Accurate identification of patients with at-risk MASH, defined as MASH with a fibrosis stage of 2 or higher, is critical for timely intervention and management. Although liver biopsy remains the gold standard for diagnosing MASH, its invasive nature, potential complications, and variability in interpretation necessitate the implementation of noninvasive tests (NITs). NITs hold the potential for reducing reliance on liver biopsies, enhancing early diagnosis, and improving patient management of chronic liver disease. Continued research and validation are essential to optimize these tools for clinical application. This article explores current NITs, including imaging biomarkers, combined imaging and serum biomarkers, advanced biomarkers and composite scores, as well as artificial intelligence-based approaches, which also show promise in improving the accuracy of noninvasive at-risk MASH detection.
代谢功能障碍相关脂肪性肝病（MASLD），以前称为非酒精性脂肪性肝病，是一个重大的全球健康问题，也是慢性肝病的主要原因。MASLD在全球的患病率正在上升，一些患者的病情会进展为代谢功能障碍相关脂肪性肝炎（MASH），这显著增加了纤维化、肝硬化和不良后果的风险。准确识别有风险的MASH患者（定义为纤维化分期为2期或更高的MASH）对于及时干预和管理至关重要。尽管肝活检仍然是诊断MASH的金标准，但其侵入性、潜在并发症以及解读的变异性使得有必要实施非侵入性检测（NITs）。NITs有可能减少对肝活检的依赖，加强早期诊断，并改善慢性肝病患者的管理。持续的研究和验证对于优化这些工具用于临床应用至关重要。本文探讨了当前的NITs，包括成像生物标志物、成像与血清生物标志物联合检测、先进生物标志物和综合评分，以及基于人工智能的方法，这些方法在提高无创性有风险MASH检测的准确性方面也显示出前景。
