慢性乙型肝炎病毒（HBV）感染患者的纤维化评估

StephenW

Ann Transl Med. 2017 Feb;5(3):40. doi: 10.21037/atm.2017.01.28.
Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection.Parikh P1, Ryan JD1, Tsochatzis EA1.
Author information

• 1UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK.
  

AbstractChronic hepatitis B virus (HBV) infection is a major cause of liver morbidity and mortality worldwide. While a proportion of the 250 million individuals chronically infected with HBV will not come to significant harm or require therapy, many others risk developing complications of the end-stage liver disease such as decompensated cirrhosis and hepatocellular carcinoma (HCC), without intervention. Due to the complex natural history of HBV infection, patients require an expert assessment to interpret biochemistry, viral serology and appropriately stage the disease, and to initiate monitoring and/or therapy where indicated. The detection and quantification of liver fibrosis is a key factor for disease management and prognostication for an individual with HBV. The reliance on invasive liver biopsy to stage disease is diminishing with the advent of robust non-invasive blood- and imaging-based algorithms which can reliably stage disease in many cases. These tests are now incorporated into International guidelines for HBV management and relied upon daily to inform clinical judgement. Both blood- and imaging-based approaches have advantages over liver biopsy, including minimal risks, lower cost, better patient acceptance and speed of results, while disadvantages include lower diagnostic accuracy in intermediate disease stages and variability with co-existing hepatic inflammation or steatosis. This review outlines the methods of fibrosis assessment in chronic HBV infection and focuses on the most commonly used blood- and imaging-based non-invasive tests, reviewing their diagnostic performance and applicability to patient care.


KEYWORDS: FIB-4; Fibroscan; cirrhosis; enhanced liver fibrosis (ELF); fibrotest

PMID:28251119DOI:10.21037/atm.2017.01.28

StephenW

Ann Transl Med。 2017 Feb; 5（3）：40。 doi：10.21037 / atm.2017.01.28。
慢性乙型肝炎病毒（HBV）感染患者的纤维化评估。
Parikh P1，Ryan JD1，Tsochatzis EA1。
作者信息

    1UCL肝脏和消化系统健康研究所和Sheila Sherlock肝脏单位，皇家自由医院和UCL，伦敦，英国。

抽象

慢性乙型肝炎病毒（HBV）感染是全世界肝脏发病率和死亡率的主要原因。虽然长期感染乙型肝炎病毒的2.5亿人中有一部分不会造成重大伤害或需要治疗，但许多其他人在没有干预的情况下，会导致终末期肝脏疾病的并发症，如失代偿性肝硬化和肝细胞癌（HCC）。由于HBV感染的复杂自然史，患者需要专家评估来解释生物化学，病毒血清学和适当地分期该疾病，并且在所指示的情况下启动监测和/或治疗。肝纤维化的检测和定量是HBV的个体的疾病管理和预后的关键因素。随着强大的非侵入性基于血液和基于成像的算法的出现，在许多情况下可靠地分期疾病，依赖浸润性肝活组织检查来分期疾病正在减少。这些测试现已纳入国际HBV管理指南，每天依赖临床判断。基于血液和基于成像的方法具有超过肝脏活检的优点，包括最小的风险，更低的成本，更好的患者接受和结果的速度，而缺点包括在中间疾病阶段的诊断准确性降低和与共存的肝脏炎症或脂肪变性。该评价概述了慢性HBV感染中纤维化评估的方法，并且集中在最常用的基于血液和基于成像的非侵入性测试，检查其诊断性能和对患者护理的适用性。
关键词：

FIB-4;纤维素;肝硬化增强肝纤维化（ELF）;纤维蛋白

PMID：
    28251119
DOI：
    10.21037 / atm.2017.01.28

StephenW

ConclusionsOther Section

In summary, a battery of non-invasive markers is available for the determination of fibrosis and monitoring the progression and regression of fibrosis in chronic HBV patients. The selection of the tests depends on individual patient factors, as well as the cost, accuracy, reliability and availability of these tests. With the constant evolution of non-invasive tests for fibrosis, which demonstrate excellent diagnostic performance for cirrhosis, as well as prognostic prediction of liver-related outcomes, the role of liver biopsy is becoming less prominent. Specifically for chronic HBV infection, treatment decisions sometimes depend on the presence of necroinflammation rather than fibrosis, therefore in such cases liver histology is still irreplaceable. The challenge now is to decide on how best to apply validated non-invasive tests in HBV management. It is likely that a combination approach (i.e., blood and imaging test at screening) will give the highest diagnostic accuracy, obviate the need for the greatest number of liver biopsies, and inform the clinician and patient regarding prognosis and the need for therapy. Furthermore, a consensus on the use of non-invasive markers to replace liver biopsy as trial endpoints would greatly enhance HBV clinical research trials, ultimately benefiting the patient.

结论其他部分

总之，一系列非侵入性标志物可用于测定慢性HBV患者的纤维化和监测纤维化的进展和消退。测试的选择取决于个体患者因素，以及这些测试的成本，准确性，可靠性和可用性。随着纤维化的非侵入性测试的不断发展，其证明了对肝硬化的良好诊断性能以及与肝脏相关的结果的预后预测，肝活检的作用变得不那么突出。特别是对于慢性HBV感染，治疗决定有时取决于坏死性炎症而不是纤维化的存在，因此在这种情况下肝组织学仍然是不可替代的。现在的挑战是决定如何最好地应用验证的非侵入性测试在HBV管理。可能的是，组合方法（即，筛选时的血液和成像测试）将给出最高的诊断准确性，消除对最大数量的肝脏活组织检查的需要，并且通知临床医生和患者关于预后和治疗的需要。此外，关于使用非侵入性标记物代替肝脏活检作为试验终点的共识将大大增强HBV临床研究试验，最终使患者受益。

StephenW

http://atm.amegroups.com/article/view/13630/13917