肝纤维化非侵入性评估的进展

StephenW

Advances in non-invasive assessment of hepatic fibrosis

    http://orcid.org/0000-0002-4845-9991Rohit Loomba1, http://orcid.org/0000-0002-3968-7909Leon A Adams2

Author affiliations

    NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, California, USA
    Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, Australia

    Correspondence to Professor Rohit Loomba, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, CA 92093, USA; [email protected]

Abstract

Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more ‘complex’ serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.
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http://dx.doi.org/10.1136/gutjnl-2018-317593

StephenW

肝纤维化非侵入性评估的进展

    http://orcid.org/0000-0002-4845-9991Rohit Loomba1，http：//orcid.org/0000-0002-3968-7909Leon A Adams2

作者单位

    加利福尼亚大学圣地亚哥分校胃肠病学和流行病学研究室NAFLD研究中心，美国加利福尼亚
    西澳大利亚大学，内德兰兹，医学和药理学，澳大利亚

    通讯作者：加利福尼亚大学圣地亚哥分校胃肠病学和流行病学系Rohit Loomba教授，美国加利福尼亚州92093； [email protected]

抽象

应当对所有患有慢性肝病的人进行肝纤维化评估，因为它可以预测未来与肝有关的发病风险，因此需要进行治疗，监测和监视。非侵入性纤维化测试（NIT）克服了肝活检的许多局限性，现在已常规纳入专业临床实践中。简单的基于血清的测试（例如，纤维化评分4，非酒精性脂肪肝疾病纤维化评分）由易于获得的生化指标和肝纤维化的临床危险因素（例如年龄和性别）组成。这些已在一系列慢性肝病中得到广泛验证，但是，其准确性不如更“复杂”的血清测试，后者结合了纤维化或纤维化的直接检测手段（例如，透明质酸，N型胶原的N末端前肽） ）。弹性成像法将肝脏僵硬程度量化为纤维化的标志物，并且比简单的血清NIT更准确，但是随着肥胖的增加，不可靠性的发生率也越来越高。 MR弹性成像看起来比超声弹性成像更准确，并且不受肥胖影响显着，但价格昂贵且可用性有限。 NITs对于排除晚期纤维化或肝硬化很有价值，但是，当单独使用时，NIT的预测能力不足。结合血清和弹性成像技术可提高诊断准确性，并可分别用作筛查和确证试验。不幸的是，尚未证明NIT能够准确反映治疗后纤维化的变化，从而限制了其在疾病监测中的作用。但是，最近的研究表明，脂质组学，蛋白质组学和肠道微生物组谱以及microRNA标记是将来有希望用于纤维化评估的技术。
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http://dx.doi.org/10.1136/gutjnl-2018-317593