非酒精性脂肪性肝病的无创性诊断方法

白阳; 张霞

doi:10.3969/j.issn.1001-5256.2013.08.022

非酒精性脂肪性肝病的无创性诊断方法

DOI: 10.3969/j.issn.1001-5256.2013.08.022

白阳,
张霞

重庆医科大学附属第二医院消化内科

详细信息

中图分类号: R575.5
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出版历程
- 收稿日期: 2012-11-14
- 出版日期: 2013-08-20

Research progress in methods for noninvasive diagnosis of nonalcoholic fatty liver disease

Bai Yang,
Zhang Xia

摘要

摘要:
肝活组织检查(LB)是评估非酒精性脂肪性肝病(NAFLD)肝脏病理损伤程度的"金标准",但因其有创性,未能广泛应用于临床。近年来非酒精性脂肪性肝炎(NASH)和进展期肝纤维化无创诊断方法研究进展较快,从临床及生物化学指标、生物标志物、影像学技术方面简述了诊断价值较高的部分无创诊断方法。目前认为NAFLD无创诊断方法尚不能取代LB,但联合应用血清细胞角蛋白18片段和NAFLD纤维化评分、瞬时弹性成像可初步诊断NASH及伴或不伴进展期肝纤维化,并进一步确定LB的使用。
- 脂肪肝 /
- 肝硬化 /
- 诊断技术,消化系统
Abstract:
Liver biopsy (LB) is considered the gold standard for assessing the pathological damage of the liver in nonalcoholic fatty liver disease (NAFLD) , but this technique is not widely applied in clinical diagnosis because it is invasive.Rapid progress has been made in the research on the methods for noninvasive diagnosis of nonalcoholic steatohepatitis (NASH) and advanced fibrosis in recent years.Some noninvasive methods with relatively high diagnostic values from the aspects of clinical and biochemical indices, biomarkers, and imaging techniques were reviewed.Currently, it is thought that the noninvasive diagnostic methods for NAFLD still cannot be used as a substitute for LB, but a combination of serum cytokeratin 18 fragments, NAFLD fibrosis score, and FibroScan can make for primary diagnosis of NASH with or without advanced fibrosis, so as to decide the use of LB.
- fatty liver /
- liver cirrhosis /
- diagnostic techniques

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参考文献(28)

[1]CHALASANI N, YOUNOSSI Z, LAVINE JE, et al.The diagnosis and management of non-alcoholic fatty liver disease:Practice guideline by the American Association for the Study of Liver Disea-ses, American College of Gastroenterology, and the American Gas-troenterological Association[J].Gastroenterology, 2012, 142 (7) :1592-1609.

[2]WU T, YIN SY, WANG HC, et al.The clinical features and risk factors of patients with metabolic syndrome combined with non-al-coholic fatty liver diseases[J].J Clin Hepatol, 2011, 27 (10) :1036-1040. (in Chinese) 吴涛, 尹守乙, 王宏长, 等.代谢综合征合并非酒精性脂肪性肝病患者的临床特点和危险因素[J].临床肝胆病杂志, 2011, 27 (10) :1036-1040.

[3]VERNON G, BARANOVA A, YOUNOSSI ZM.Systematic review:the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults[J].Aliment Pharmacol Ther, 2011, 34 (3) :274-285.

[4]ROCKEY DC, CALDWELL SH, GOODMAN ZD, et al.Liver bi-opsy[J].Hepatology, 2009, 49 (3) :1017-1044.

[5]POYNARD T, RATZIU V, CHARLOTTE F, et al.Diagnostic val-ue of biochemical markers (NashTest) for the prediction of non al-coholo steato hepatitis in patients with non-alcoholic fatty liver dis-ease[J].BMC Gastroenterol, 2006, 6:34.

[6]FELDSTEIN AE, CANBAY A, ANGULO P, et al.Hepatocyte ap-optosis and fas expression are prominent features of human nonalco-holic steatohepatitis[J].Gastroenterology, 2003, 125 (2) :437-443.

[7]WIECKOWSKA A, ZEIN NN, YERIAN LM, et al.In vivo assess-ment of liver cell apoptosis as a novel biomarker of disease severityin nonalcoholic fatty liver disease[J].Hepatology, 2006, 44 (1) :27-33.

[8]FELDSTEIN AE, WIECKOWSKA A, LOPEZ AR, et al.Cytokera-tin-18fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis:a multicenter validation study[J].Hepatology, 2009, 50 (4) :1072-1078.

[9]DIAB DL, YERIAN L, SCHAUER P, et al.Cytokeratin18frag-ment levels as a noninvasive biomarker for nonalcoholic steatohepati-tis in bariatric surgery patients[J].Clin Gastroenterol Hepatol, 2008, 6 (11) :1249-1254.

[10]MUSSO G, GAMBINO R, CASSADER M, et al.Meta-analysis:natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity[J].Ann Med, 2011, 43 (8) :617-649.

[11]STAUB F, TOURNOUX-FACON C, ROUMY J, et al.Liver fi-brosis staging with contrast-enhanced ultrasonography:prospective multicenter study compared with METAVIR scoring[J].Eur Radi-ol, 2009, 19 (8) :1991-1997.

[12]IIJIMA H, MORIYASU F, TSUCHIYA K, et al.Decrease in accumu-lation of ultrasound contrast microbubbles in non-alcoholic steatohepa-titis[J].Hepatol Res, 2007, 37 (9) :722-730.

[13]HARRISON SA, OLIVER D, ARNOLD HL, et al.Development and validation of a simple NAFLD clinical scoring system for identif-ying patients without advanced disease[J].Gut, 2008, 57 (10) :1441-1447.

[14]ANGULO P, HUI JM, MARCHESINI G, et al.The NAFLD fibrosis score:a noninvasive system that identifies liver fibrosis in patients with NAFLD[J].Hepatology, 2007, 45 (4) :846-854.

[15]QURESHI K, CLEMENTS RH, ABRAMS GA.The utility of the“NAFLD fibrosis score”in morbidly obese subjects with NAFLD[J].Obes Surg, 2008, 18 (3) :264-270.

[16]RUFFILLO G, FASSIO E, ALVAREZ E, et al.Comparison of NAFLD fibrosis score and BARD score in predicting fibrosis in non-alcoholic fatty liver disease[J].J Hepatol, 2011, 54 (1) :160-163.

[17]McPHERSON S, STEWART SF, HENDERSON E, et al.Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease[J].Gut, 2010, 59 (9) :1265-1269.

[18]HALFON P, MUNTEANU M, POYNARD T.FibroTest-ActiTestas a non-invasive marker of liver fibrosis[J].Gastroenterol Clin Biol, 2008, 32 (6Suppl1) :22-39.

[19]POYNARD T, MORRA R, HALFON P, et al.Meta-analyses of FibroTest diagnostic value in chronic liver disease[J].BMC Gastro-enterol, 2007, 7:40.

[20]MUNTEANU M, RATZIU V, MORRA R, et al.Noninvasive bio-markers for the screening of fibrosis, steatosis and steatohepatitis in patients with metabolic risk factors:FibroTest-FibroMax experi-ence[J].J Gastrointestin Liver Dis, 2008, 17 (2) :187-191.

[21]GUHA IN, PARKES J, RODERICK P, et al.Noninvasive markers of fibrosis in nonalcoholic fatty liver disease:Validating the European Liv-er Fibrosis Panel and exploring simple markers[J].Hepatology, 2008, 47 (2) :455-460.

[22]PARKES J, RODERICK P, HARRIS S, et al.Enhanced liver fi-brosis test can predict clinical outcomes in patients with chronic liver disease[J].Gut, 2010, 59 (9) :1245-1251.

[23]SANDRIN L, TANTER M, CATHELINE S, et al.Shear modulus imaging with2-D transient elastography[J].IEEE Trans Ultrason Ferroelectr Freq Control, 2002, 49 (4) :426-435.

[24]TAN YJ, JI D, NIU XX, et al.Frequency and determinants of liver stiffness measurement failure[J].J Med Res, 2012, 41 (11) :30-33. (in Chinese) 谭有娟, 纪冬, 牛小霞, 等.瞬时弹性成像检测肝硬度失败的因素及分析[J].医学研究杂志, 2012, 41 (11) :30-33.

[25]YONEDA M, FUJITA K, INAMORI M, et al.Transient elastogra-phy in patients with non-alcoholic fatty liver disease (NAFLD) [J].Gut, 2007, 56 (9) :1330-1331.

[26]WONG VW, VERGNIOL J, WONG GL, et al.Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease[J].Hepatology, 2010, 51 (2) :454-462.

[27]de LéDINGHEN V, VERGNIOL J, FOUCHER J, et al.Feasibility of liver transient elastography with FibroScan using a new probe for obese patients[J].Liver Int, 2010, 30 (7) :1043-1048.

[28]PALMERI ML, WANG MH, ROUZE NC, et al.Noninvasive eval-uation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease[J].J Hep-atol, 2011, 55 (3) :666-672.

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