肝纤维化无创诊断研究进展及其临床应用

Development and clinical application of noninvasive methods to assess liver fibrosis

肝纤维化是各种病因所致慢性肝损伤引起的细胞外基质的过度积聚,最终可能发展成肝硬化。对慢性肝病肝纤维化程度的评估尤为重要,是判断病情、决定是否进行治疗及随访疗效的关键环节。肝脏活体组织检查(肝活检)目前仍被认为是诊断肝纤维化的"金标准",但由于其有创性,可引起危及生命的并发症,即使可能性很低,仍然限制了它的进一步应用。近年来发展起来的无创性肝纤维化诊断方法逐渐成为国内外学者关注的热点,这些方法完全不同却又相互补充,包括生物学途径,如检测各种肝纤维化的血清学标志物水平;也包括一些物理途径,如通过超声或磁共振弹性成像方法来评价肝组织硬度。这些无创诊断方法首先用于并且确证于慢性丙型肝炎患者,目前正逐渐扩展至其他慢性肝病,如慢性乙型肝炎、非酒精性脂肪性肝病和自身免疫性肝病等,从而降低了肝活检的需求。本文就肝纤维化无创诊断的优缺点和临床应用等方面进行综述。

Liver fibrosis is the excessive accumulation of extracellular matrix （ECM） proteins resulting from chronic liver diseases （CLD）, which may eventually progress to liver cirrhosis. Therefore, an accurate assessment of the extent of liver fibrosis is important for predicting the prognosis, determining the appropriate management and assessing the therapeutic efficacy of CLD patients. Until recently, liver biopsy is still considered to be the ＂gold standard＂ for staging of fibrosis, but it is an invasive procedure with rare but potentially life-threatening complications, which restricts its further clinical applications. It has been challenged over the recent years by the development of noninvasive methods, which include distinct but complementary approaches： biologic approaches such as quantifying serum levels of biomarkers of fibrosis, and physical approaches such as measuring liver stiffness by ultrasound or magnetic resonance elastography. These methods were initially applied and validated in patients with chronic hepatitis C but are now used increasingly in other CLD, such as chronic hepatitis B, non-alcoholic fatty liver disease and autoimmune liver disease, etc., reducing the need for liver biopsy. This review focuses on the advantages, limitations and their clinical applications of these noninvasive methods.