Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease.
Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease.
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DOI：
10.1053/j.gastro.2018.12.036
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发表时间：
2019-04
期刊：
影响因子：
29.4
通讯作者：
Loomba R
中科院分区：
文献类型：
--
作者：
Castera L;Friedrich-Rust M;Loomba R
据估计，全世界约有10亿人患有非酒精性脂肪性肝病。在非酒精性脂肪性肝炎（NASH）的进行性NAFLD患者亚群中，可发展为晚期纤维化、肝硬化、肝细胞癌和肝脏相关的发病率和死亡率。NASH的典型特征是肝脏组织学上的特定模式，包括脂肪变性、小叶炎症和伴或不伴窦周纤维化的球囊。因此，NAFLD患者的关键问题是NASH与单纯性脂肪变性的鉴别和晚期肝纤维化的鉴别。到目前为止，肝活检一直是确定这两个关键终点的金标准，但它有众所周知的局限性，包括侵入性；罕见但可能危及生命的并发症；可怜的可接受性;抽样的可变性;和成本。此外，由于全球范围内NAFLD个体的流行比例，肝活检评估不切实际，需要无创评估来诊断NASH和纤维化。尽管在建立具有成本效益的NASH、晚期纤维化和肝硬化筛查策略方面还有很多工作要做，但在这篇综述中，我们总结了NAFLD中肝脏疾病无创评估的现状，并提供了如何将这些无创工具应用于临床实践的专家综合。最后，我们还列出了该领域的重点研究领域，以推进临床实践。
Nonalcoholic fatty liver disease (NAFLD) is estimated to afflict approximately 1 billion individuals worldwide. In a subset of NAFLD patients, who have the progressive form of NAFLD termed nonalcoholic steatohepatitis (NASH), it can progress to advanced fibrosis, cirrhosis, hepatocellular carcinoma, and liver-related morbidity and mortality. NASH is typically characterized by a specific pattern on liver histology, including steatosis, lobular inflammation, and ballooning with or without peri-sinusoidal fibrosis. Thus, key issues in NAFLD patients are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. Until now, liver biopsy has been the gold standard for identifying these 2 critical end points, but has well-known limitations, including invasiveness; rare but potentially life-threatening complications; poor acceptability; sampling variability; and cost. Furthermore, due to the epidemic proportion of individuals with NAFLD worldwide, liver biopsy evaluation is impractical, and noninvasive assessment for the diagnosis of NASH and fibrosis is needed. Although much of the work remains to be done in establishing cost-effective strategies for screening for NASH, advanced fibrosis, and cirrhosis, in this review, we summarize the current state of the noninvasive assessment of liver disease in NAFLD, and we provide an expert synthesis of how these noninvasive tools could be utilized in clinical practice. Finally, we also list the key areas of research priorities in this area to move forward clinical practice.
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