The Role of Noninvasive Tests for Differentiating NASH From NAFL and Diagnosing Advanced Fibrosis Among Patients With NAFLD.
The Role of Noninvasive Tests for Differentiating NASH From NAFL and Diagnosing Advanced Fibrosis Among Patients With NAFLD.
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DOI：
10.1097/mcg.0000000000001284
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发表时间：
2020-02
影响因子：
2.9
通讯作者：
Loomba R
中科院分区：
文献类型：
--
作者：
Balakrishnan M;Loomba R
评估非酒精性脂肪性肝炎（NASH）的存在和晚期纤维化的存在对于非酒精性脂肪性肝病（NAFLD）患者至关重要，因为每一种都可以预测疾病结局。肝活检是这样做的金标准方法，但不可能在所有NAFLD患者中进行。因此，迫切需要用于非侵入性检测NASH和晚期纤维化的存在的可靠方法。对于晚期纤维化的非侵入性检测的研究比NASH更成功。临床预测模型和弹性成像在排除晚期纤维化方面具有可接受的准确性;当一起使用时，如在本综述中提出的纤维化预测算法中，它可以避免许多NAFLD患者需要进行肝活检。已经研究了几种用于鉴定NASH存在的生物标志物，但没有一种是足够准确或有效的。在这些研究中，最有希望的包括CK-18片段，脂质组学和代谢组学候选者，以及质子密度脂肪分数的磁共振弹性成像。然而，没有一个可以用于临床，最终需要大型多中心前瞻性队列研究来验证选择的新型生物标志物。
Assessing for the presence of non–alcoholic steatohepatitis (NASH) and the presence of advanced fibrosis is vital among patients with non–alcoholic fatty liver disease (NAFLD) as each is predictive of disease outcomes. A liver biopsy is the gold standard method for doing so but is impossible to perform among all patients with NAFLD. Reliable methods for noninvasively detecting for the presence of NASH and advanced fibrosis are thus a pressing need. The search for noninvasive tests has been more successful for advanced fibrosis than for NASH. Clinical prediction models and elastography have acceptable accuracy for ruling out advanced fibrosis; when used together, as in a fibrosis prediction algorithm presented in this review, it can avoid the need for liver biopsy among many patients with NAFLD. Several biomarkers for identifying the presence of NASH have been studied but none are sufficiently accurate or validated. Of those studied, the most promising include CK-18 fragments, lipodomic and metabolomics candidates, and magnetic resonance elastography with proton density fat fraction. However, none are ready for clinical use and ultimately large multicenter prospective cohort studies are needed to validate select novel biomarkers.