Non-invasive Markers of Liver Fibrosis: Adjuncts or Alternatives to Liver Biopsy?
Non-invasive Markers of Liver Fibrosis: Adjuncts or Alternatives to Liver Biopsy?
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DOI：
10.3389/fphar.2016.00159
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发表时间：
2016
影响因子：
5.6
通讯作者：
Ryan JD
中科院分区：
文献类型：
--
作者：
Chin JL;Pavlides M;Moolla A;Ryan JD
肝纤维化反映了通常由多个同时发生的因素造成的持续性肝损伤。虽然活检中出现轻度纤维化可能令人放心，但晚期纤维化的识别对于慢性肝病患者的治疗至关重要。这种必要性导致了对肝活检的依赖，而肝活检本身是一种不完善的测试，并且很难被患者接受。用于非侵入性评估肝纤维化的强大工具的开发极大地增强了慢性肝病患者的临床决策，从而可以快速、明智地判断疾病阶段和预后。如果需要进行肝活检，使用这些辅助手段的适当性会更明确，诊断率也会更高。虽然许多非侵入性肝纤维化标记物现已用于常规实践，但仍存在源源不断的创新方法。随着这些标记物的可靠性、可重复性和可行性的提高，它们在疾病管理中的潜在作用正在增强。此外，将它们作为结果指标纳入临床试验反映了它们的有效性和动态性质。本综述将总结和评估当前和新型的基于血液和影像的肝纤维化非侵入性标志物，并探讨它们在日常临床护理中的前景应用。
Liver fibrosis reflects sustained liver injury often from multiple, simultaneous factors. Whilst the presence of mild fibrosis on biopsy can be a reassuring finding, the identification of advanced fibrosis is critical to the management of patients with chronic liver disease. This necessity has lead to a reliance on liver biopsy which itself is an imperfect test and poorly accepted by patients. The development of robust tools to non-invasively assess liver fibrosis has dramatically enhanced clinical decision making in patients with chronic liver disease, allowing a rapid and informed judgment of disease stage and prognosis. Should a liver biopsy be required, the appropriateness is clearer and the diagnostic yield is greater with the use of these adjuncts. While a number of non-invasive liver fibrosis markers are now used in routine practice, a steady stream of innovative approaches exists. With improvement in the reliability, reproducibility and feasibility of these markers, their potential role in disease management is increasing. Moreover, their adoption into clinical trials as outcome measures reflects their validity and dynamic nature. This review will summarize and appraise the current and novel non-invasive markers of liver fibrosis, both blood and imaging based, and look at their prospective application in everyday clinical care.