A practical clinical approach to liver fibrosis
A practical clinical approach to liver fibrosis
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DOI：
10.11622/smedj.2018145
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发表时间：
2018-12-01
影响因子：
2.7
通讯作者：
Ang, Tiing Leong
中科院分区：
文献类型：
--
作者：
Kumar, Rahul;Teo, Eng Kiong;Ang, Tiing Leong
肝纤维化是一个缓慢的、潜伏的过程，涉及细胞外基质蛋白在肝脏中的积聚。慢性肝病(CLD)肝纤维化的分期决定了总的发病率和死亡率，分期越高，预后越差。非侵入性综合评分可用于确定CLD患者是否有明显的或晚期的纤维化。综合评分低的患者可以通过定期重新评估在初级保健中得到安全的随访。那些得分较高的人应该被推荐给专家。随着糖尿病、肥胖症和非酒精性脂肪性肝病的流行，慢性肝病变得越来越普遍。易于使用的纤维化评估综合评分可以识别轻度或晚期纤维化患者，应该是决策的组成部分。有肝硬变、高综合评分、慢性乙型病毒性肝炎丙氨酸氨基转移酶和天冬氨酸氨基转移酶升高的患者，或病因不明的错乱肝病患者应转诊至专科医生。
Liver fibrosis is a slow, insidious process involving accumulation of extracellular matrix protein in the liver. The stage of liver fibrosis in chronic liver disease (CLD) determines overall morbidity and mortality; the higher the stage, the worse the prognosis. Noninvasive composite scores can be used to determine whether patients with CLD have significant or advanced fibrosis. Patients with low composite scores can be safely followed up in primary care with periodic reassessment. Those with higher scores should be referred to a specialist. As the epidemic of diabetes mellitus, obesity and non-alcoholic fatty liver diseases is rising, CLD is becoming more prevalent. Easy-to-use fibrosis assessment composite scores can identify patients with minimal or advanced fibrosis, and should be an integral part of decision-making. Patients with cirrhosis, high composite scores, chronic hepatitis B with elevated alanine aminotransferase and aspartate aminotransferase, or deranged liver panel of uncertain aetiology should be referred to a specialist.