Quantitative assessment of liver fibrosis: invasive or non-invasive?
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摘要: 准确量化评估肝纤维化程度对明确疾病诊断、治疗决策、监测疗效及判断预后均有重要参考价值。分析了有创及无创肝纤维化定量诊断方法的发展及应用现状。基于有创肝活组织检查的肝纤维化诊断方法已从描述性肝组织学评估发展到半定量分析,全量化客观测量肝纤维化技术可望改善传统半定量分析方法的观察者间误差、取样误差等不足;无创肝纤维化诊断方法则弥补了肝活组织检查的有创性、取样误差等不足,且对疾病远期结局有较好预测价值,但对肝纤维化动态变化的监测价值仍需要肝组织学分析的平行验证。由此认为,肝纤维化的无创评估方法尚不能完全替代肝组织学检查,但在明确诊断的患者中可减少肝活组织检查次数;无创诊断方法在肝纤维化动态监测的应用能力有待更多拓展与验证,而肝组织纤维化量化诊断方法也需要进一步验证其发现与疾病长期预后的关系。Abstract: Precise and quantitative assessment of the severity of liver fibrosis is of great value for confirming diagnosis,making treatment decision,monitoring treatment outcome,and determining prognosis. This paper analyzes the development and application of invasive and non- invasive quantitative assessment of histological liver fibrosis. From the first descriptive histological evaluation,the assessment of liver fibrosis based on invasive liver biopsy has been developed into semi- quantitative approaches. The fully- quantitative and objective assessment of histological liver fibrosis can overcome drawbacks of traditional semi- quantitative approaches including observer bias and sampling error. The non- invasive assessment of liver fibrosis not only overcomes drawbacks of liver biopsy including invasion and sampling error,but also holds promise for predicting the long- term outcome of disease,though its application in monitoring dynamic changes in liver fibrosis still needs to be confirmed by liver histological evaluation. Therefore,the non- invasive assessment of liver fibrosis cannot yet completely replace liver histological evaluation,but it can reduce the number of liver biopsies in patients with definitive diagnosis. The application of the non- invasive diagnostic method in monitoring dynamic changes in liver fibrosis needs to be validated at more clinical settings,and for the quantitative assessment of histological liver fibrosis,the correlation of clinical relevance between the results and the long- term outcomes needs to be systematically identified.
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Key words:
- liver cirrhosis /
- biopsy,fine-needle /
- diagnostic techniques and procedures /
- editorial
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