肝纤维化的非侵入性评估 - 我们渴望的水晶球。

StephenW

J Gastroenterol Hepatol. 2018 Jan 30. doi: 10.1111/jgh.14103. [Epub ahead of print]
Non-invasive assessments for liver fibrosis - the crystal ball we long for.Wong GL1,2,3.
Author information
1Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.3State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.

AbstractNon-invasive assessment of liver fibrosis has been one of the most rapidly advancing fields in hepatology in the last decade. Progressive liver fibrosis results in cirrhosis, hepatocellular carcinoma (HCC) and various liver-related complications in essentially all chronic liver diseases. Assessment of liver fibrosis allows clinicians to determine the prognosis, need of treatment, disease progression and response to treatment in patients with chronic liver disease. Liver biopsy has been the gold standard in last few decades and most adopted diagnostic tool in clinical trials. Nonetheless, it is impractical to apply the test in a large number of patients or to do it serially. Hence, various non-invasive assessments have been developed and adopted in some international management guidelines. Liver stiffness measurement (LSM) with transient elastography one of the most widely validated non-invasive assessments for liver fibrosis. It is an accurate and reproducible method to predict advanced fibrosis in chronic hepatitis B. Using transient elastography, it is possible to perform repeated liver fibrosis assessments on a large number of asymptomatic patients. The key challenge of his tool is the confounding effect of alanine aminotransferase (ALT) level, such that decrease in LSM may only reflect ALT normalization, hence not accurate enough to indicate regression of liver fibrosis. This may be partially handled by combining LSM with a serum-based formula which is independent of ALT such as the Forns index and Enhanced Liver Fibrosis test. A LSM-based HCC risk score (LSM-HCC score) is useful to prioritize patients for HCC surveillance.


KEYWORDS: (not in the title): Chronic hepatitis B; chronic hepatitis C; fatty liver; transient elastography

PMID:29380413DOI:10.1111/jgh.14103

StephenW

J Gastroenterol Hepatol。 2018年1月30日。doi：10.1111 / jgh.14103。 [电子版提前打印]
肝纤维化的非侵入性评估 - 我们渴望的水晶球。
王GL1,2,3。
作者信息

1
    香港中文大学消化疾病研究所。
2
    香港中文大学医学与治疗学系。
3
    香港中文大学消化疾病国家重点实验室，香港。

抽象

肝脏纤维化的无创性评估是近十年来肝脏疾病发展最迅速的领域之一。进行性肝纤维化导致基本上所有慢性肝病中的肝硬化，肝细胞癌（HCC）和各种肝相关并发症。肝纤维化的评估允许临床医生确定慢性肝病患者的预后，治疗需要，疾病进展和治疗反应。在过去的几十年里，肝活检已经成为了金标准，大多数在临床试验中采用了诊断工具。尽管如此，将这种检测方法应用于大量患者或连续检测是不切实际的。因此，一些国际管理准则已经制定并采用了各种非侵入性评估。肝硬度测量（LSM）与瞬时弹性成像是最广泛验证的肝脏纤维化非侵入性评估之一。这是一种准确和可重复的方法来预测慢性乙型肝炎的晚期纤维化。使用瞬时弹性成像，可以对大量无症状患者进行反复的肝纤维化评估。他的工具的关键挑战是丙氨酸转氨酶（ALT）水平的混杂效应，使得LSM下降可能仅反映ALT正常化，因此不足以说明肝纤维化的消退。这可以通过将LSM与独立于ALT的基于血清的配方例如Forns指数和增强的肝纤维化测试相结合来部分处理。基于LSM的HCC风险评分（LSM-HCC评分）对于优先考虑HCC监测的患者是有用的。
关键词：

（不在标题中）：慢性乙型肝炎;慢性丙型肝炎;脂肪肝;瞬时弹性成像

结论：
    29380413
DOI：
    10.1111 / jgh.14103

tacolynn

ALT正常说明没有炎症或者炎症轻微，但是不足以说明肝纤维化是否好转。

StephenW

回复 tacolynn 的帖子

正确.
文章的 意义是 - 当ALT高 Fibroscan也提高, 因此当Fibroscan降低, 也许只是因为ALT降低, 不是纤维化好转.

vipcgm

这么说，那是不是就意味着做FIBROSCAN检查的意义就不大了？

StephenW

vipcgm 发表于 2018-2-1 10:33
这么说，那是不是就意味着做FIBROSCAN检查的意义就不大了？

不是!
当ALT高做FIBROSCAN检查, Fibroscan也提高(不准确), 因此还需要同时有"独立于ALT的基于血清的配方例如Forns指数"