基于病理和影像学的肝纤维化量化评估技术的临床应用

何志颖; 王冰琼; 尤红

doi:10.3969/j.issn.1001-5256.2018.01.003

基于病理和影像学的肝纤维化量化评估技术的临床应用

DOI: 10.3969/j.issn.1001-5256.2018.01.003

首都医科大学附属北京友谊医院肝病中心, 国家消化系统疾病临床医学研究中心

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2460
- HTML全文浏览量: 16
- PDF下载量: 582
- 被引次数: 0
出版历程
- 出版日期: 2018-01-20

Clinical application of quantitative assessment of liver fibrosis based on pathology and imaging technology

Liver Research Center, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing 100050, China

摘要

摘要: 肝纤维化/肝硬化是慢性肝脏疾病的常见病理结局,准确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。目前两类量化评估技术得到了较为广泛应用,一是基于肝穿刺病理的量化评估技术,为细化肝纤维化分期及评估肝纤维化进展和逆转提供了金标准;二是基于影像学的无创量化评估技术,因其可重复性而在肝纤维化的动态监测与临床转归预测中发挥重要作用。主要介绍了上述两类量化评估技术的发展及其临床应用,以期更好地指导临床实践。
- 肝硬化 /
- 诊断显像 /
- 活组织检查,针吸
Abstract: Liver fibrosis/cirrhosis is a common pathological outcome of chronic hepatic diseases, and an accurate assessment of the degree of liver fibrosis has an important reference value in a definite diagnosis, treatment decision-making, clinical outcome monitoring, and prognostic evaluation. Two quantitative assessment techniques are widely used at present: the quantitative assessment technique based on liver biopsy is the gold standard for identifying the exact liver fibrosis stage and evaluating the progression and reversion of liver fibrosis; the noninvasive quantitative assessment technique based on imaging technology plays an important role in dynamic monitoring and prognostic prediction of liver fibrosis due to its repeatability. This article summarizes the development and application of these two quantitative assessment techniques to provide guidance for clinical practice.
- liver cirrhosis /
- diagnostic imaging /
- biopsy, needle

HTML全文

参考文献(34)

[1]LIANG XE, WANG Y, HOU JL.Quantitative assessment of liver fibrosis:invasive or non-invasive?[J].J Clin Hepatol, 2015, 31 (3) :317-321. (in Chinese) 梁携儿, 汪艳, 侯金林.肝纤维化定量诊断:有创还是无创?[J].临床肝胆病杂志, 2015, 31 (3) :317-321.

[2]WANG BQ, SUN YM, YOU H, et al.Pathological assessment of liver fibrosis regression[J].J Clin Hepatol, 2017, 33 (3) :435-437. (in Chinese) 王冰琼, 孙亚朦, 尤红, 等.肝纤维化逆转的病理评估[J].临床肝胆病杂志, 2017, 33 (3) :435-437.

[3]ISHAK K, BAPTISTA A, BIANCHI L, et al.Histological grading and staging of chronic hepatitis[J].J Hepatol, 1995, 22 (6) :696-699.

[4]BEDOSSA P, POYNARD T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology, 1996, 24 (2) :289-293.

[5]TENG XY, ZHOU XG, SUN L, et al.Application of a refined fibrosis staging system to evaluate therapeutic efficacy in chronic viral hepatitis[J].Chin J Hepatol, 2013, 21 (4) :271-274. (in Chinese) 滕晓英, 周新刚, 孙磊, 等.细化慢性肝炎肝纤维化分期标准在药物疗效评定中的应用[J].中华肝脏病杂志, 2013, 21 (4) :271-274.

[6]SUN Y, ZHOU J, WANG L, et al.New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment[J].Hepatology, 2017, 65 (5) :1438-1450.

[7]JIMENEZ W, PARES A, CABALLERIA J, et al.Measurement of fibrosis in needle liver biopsies:evaluation of a colorimetric method[J].Hepatology, 1985, 5 (5) :815-818.

[8]CALVARUSO V, BURROUGHS AK, STANDISH R, et al.Computer-assisted image analysis of liver collagen:relationship to Ishak scoring and hepatic venous pressure gradient[J].Hepatology, 2009, 49 (4) :1236-1244.

[9]PAVLIDES M, BIRKS J, FRYER E, et al.Interobserver variability in histologic evaluation of liver fibrosis using categorical and quantitative scores[J].Am J Clin Pathol, 2017, 147 (4) :364-369.

[10]GOODMAN ZD, BECKER RL Jr, POCKROS PJ, et al.Progression of fibrosis in advanced chronic hepatitis C:evaluation by morphometric image analysis[J].Hepatology, 2007, 45 (4) :886-894.

[11]TSOCHATZIS E, BRUNO S, ISGRO G, et al.Collagen proportionate area is superior to other histological methods for sub-classifying cirrhosis and determining prognosis[J].J Hepatol, 2014, 60 (5) :948-954.

[12]ISGRO G, CALVARUSO V, ANDREANA L, et al.The relationship between transient elastography and histological collagen proportionate area for assessing fibrosis in chronic viral hepatitis[J].J Gastroenterol, 2013, 48 (8) :921-929.

[13]BEDOSSA P, DARGERE D, PARADIS V.Sampling variability of liver fibrosis in chronic hepatitis C[J].Hepatology, 2003, 38 (6) :1449-1457.

[14]O'BRIEN MJ, KEATING NM, ELDERINY S, et al.An assessment of digital image analysis to measure fibrosis in liver biopsy specimens of patients with chronic hepatitis C[J].Am J Clin Pathol, 2000, 114 (5) :712-718.

[15]XU S, WANG Y, TAI DCS, et al.q Fibrosis:a fully-quantitative innovative method incorporating histological features to facilitate accurate fibrosis scoring in animal model and chronic hepatitis B patients[J].J Hepatol, 2014, 61 (2) :260-269.

[16]WANG Y, HOU JL.Current strategies for quantitating fibrosis in liver biopsy[J].Chin Med J (Engl) , 2015, 128 (2) :252-258.

[17]VERGNIOL J, FOUCHER J, CASTERA L, et al.Changes of non-invasive markers and Fibro Scan values during HCV treatment[J].J Viral Hepat, 2009, 16 (2) :132-140.

[18]FRIEDRICH-RUST M, LUPSOR M, de KNEGT R, et al.Point shear wave elastography by acoustic radiation force impulse quantification in comparison to transient elastography for the noninvasive assessment of liver fibrosis in chronic hepatitis C:a prospective international multicenter study[J].Ultraschall Med, 2015, 36 (3) :239-247.

[19]FRIEDRICH-RUST M, ONG MF, MARTENS S, et al.Performance of transient elastography for the staging of liver fibrosis:a meta-analysis[J].Gastroenterology, 2008, 134 (4) :960-974.

[20]CHEN YP, LIANG XE, ZHANG Q, et al.Larger biopsies evaluation of transient elastography for detecting advanced fibrosis in patients with compensated chronic hepatitis B[J].J Gastroenterol Hepatol, 2012, 27 (7) :1219-1226.

[21]ROBIC MA, PROCOPET B, METIVIER S, et al.Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease:a prospective study[J].J Hepatol, 2011, 55 (5) :1017-1024.

[22]WU S, KONG Y, PIAO H, et al.On-treatment changes of liver stiffness at week 26 could predict 2-year clinical outcomes in HBV-related compensated cirrhosis[J].Liver Int, 2017.[Epub ahead of print]

[23]KIM MN, KIM SU, KIM BK, et al.Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis[J].Hepatology, 2015, 61 (6) :1851-1859.

[24]CORPECHOT C, CARRAT F, POUJOL-ROBERT A, et al.Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis[J].Hepatology, 2012, 56 (1) :198-208.

[25]VERGNIOL J, BOURSIER J, COUTZAC C, et al.Evolution of noninvasive tests of liver fibrosis is associated with prognosis in patients with chronic hepatitis C[J].Hepatology, 2014, 60 (1) :65-76.

[26]PONS M, SANTOS B, SIMON-TALERO M, et al.Rapid liver and spleen stiffness improvement in compensated advanced chronic liver disease patients treated with oral antivirals[J].Therap Adv Gastroenterol, 2017, 10 (8) :619-629.

[27]BOTA S, HERKNER H, SPOREA I, et al.Meta-analysis:ARFI elastography versus transient elastography for the evaluation of liver fibrosis[J].Liver Int, 2013, 33 (8) :1138-1147.

[28]KOBAYASHI K, NAKAO H, NISHIYAMA T, et al.Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis:a meta-analysis[J].Eur Radiol, 2015, 25 (1) :230-238.

[29]TAKUMA Y, MORIMOTO Y, TAKABATAKE H, et al.Measurement of spleen stiffness with acoustic radiation force impulse imaging predicts mortality and hepatic decompensation in patients with liver cirrhosis[J].Clin Gastroenterol Hepatol, 2017, 15 (11) :1782-1790.

[30]European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado.EASL-ALEH clinical practice guidelines:non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol, 2015, 63 (1) :237-264.

[31]SINGH S, VENKATESH SK, WANG Z, et al.Diagnostic performance of magnetic resonance elastography in staging liver fibrosis:a systematic review and meta-analysis of individual participant data[J].Clin Gastroenterol Hepatol, 2015, 13 (3) :440-451.

[32]KIM SU, PARK JY, KIM DY, et al.Non-invasive assessment of changes in liver fibrosis via liver stiffness measurement in patients with chronic hepatitis B:impact of antiviral treatment on fibrosis regression[J].Hepatol Int, 2010, 4 (4) :673-680.

[33]FUNG J, LAI CL, WONG DK, et al.Significant changes in liver stiffness measurements in patients with chronic hepatitis B:3-year follow-up study[J].J Viral Hepat, 2011, 18 (7) :e200-e205.

[34]WONG GL, WONG VW, CHOI PC, et al.On-treatment monitoring of liver fibrosis with transient elastography in chronic hepatitis B patients[J].Antivir Ther, 2011, 16 (2) :165-172.

施引文献

资源附件(0)

访问统计