Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: Why liver biopsy is essential
Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: Why liver biopsy is essential
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DOI：
10.1111/liv.13653
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发表时间：
2018-02-01
影响因子：
6.7
通讯作者：
Bedossa, Pierre
中科院分区：
文献类型：
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作者：
Bedossa, Pierre
非酒精性脂肪性肝病的模式是复杂的，与几种病变相关，每种病变与不同的病理生理机制有关。尽管非侵入性工具取得了进展，但肝活检仍然是唯一能够可靠评估这些不同模式及其相关严重程度和关联的诊断程序。肝活检最重要的困难可以避免，如果这个程序是由一个有经验的肝病学家和阅读由肝脏病理学家。然而，由于显而易见的原因，活检应限于选定的患者，特别是在临床试验的背景下。事实上，监管机构认为肝活检是强制性的，作为评估III期临床试验药物疗效的替代方法。除了临床诊断外，肝活检还可用于对疾病的各种组织学模式（NASH-CRN，SAF评分）进行评分，并准确评估纤维化程度，这两者在进行随访活检时都很有用。当治疗在不久的将来可用时，肝活检可能仍然有助于根据主要的主要组织学特征（活动性、脂肪变性、纤维化）选择最合适的治疗方案。
The pattern of non-alcoholic fatty liver disease is complex with an association of several lesions, each of them related to different pathophysiological mechanisms. Despite the progress in non-invasive tools, liver biopsy remains the only diagnostic procedure that can reliably assess these various patterns, their related severity and associations. The most important difficulties of liver biopsy can be avoided if this procedure is performed by an experienced hepatologist and read by a liver pathologist. However, for obvious reasons, biopsy should be restricted to selected patients, especially in the context of clinical trials. Indeed, liver biopsy is considered mandatory by regulatory authorities as a surrogate to assess drug efficacy in Phase 3 clinical trials. In addition to the clinical diagnosis, liver biopsy can be used to score the various histological patterns of disease (NASH-CRN, SAF scores) and accurately assess the extent of fibrosis, both of which are useful when follow-up biopsies are performed. When treatment becomes available in the near future, liver biopsy could remain useful for choosing the most suitable therapeutic option based on the main predominant histological features (activity, steatosis, fibrosis).