摘要
Nonalcoholic fatty liver disease(NAFLD) is the commonest chronic liver disease and includes simple steatosis and nonalcoholic steatohepatitis(NASH). Since NASH progresses to cirrhosis more frequently and increases liver-related and cardiovascular disease risk substantially more than simple steatosis, there is a great need to differentiate the two entities. Liver biopsy is the gold standard for the diagnosis of NAFLD but its disadvantages, including the risk of complications and sampling bias, stress the need for developing alternative diagnostic methods. Accordingly, several non-invasive markers have been evaluated for the diagnosis of simple steatosis and NASH, including both serological indices and imaging methods. The present review summarizes the current knowledge on the role of these markers in the diagnosis of NAFLD. Current data suggest that ultrasound and the fibrosis-4 score are probably the most appealing methods for detecting steatosis and for distinguishing NASH from simple steatosis, respectively, because of their low cost and relatively high accuracy. However, currently available methods, both serologic and imaging, cannot obviate the need for liver biopsy for diagnosing NASH due to their substantial false positive and false negative rates. Therefore, the current role of these methods is probably limited in patients who are unwilling or have contraindications for undergoing biopsy.
Nonalcoholic fatty liver disease （NAFLD） is thecommonest chronic liver disease and includes simplesteatosis and nonalcoholic steatohepatitis （NASH）.Since NASH progresses to cirrhosis more frequentlyand increases liver-related and cardiovascular diseaserisk substantially more than simple steatosis, there is agreat need to differentiate the two entities. Liver biopsyis the gold standard for the diagnosis of NAFLD butits disadvantages, including the risk of complicationsand sampling bias, stress the need for developingalternative diagnostic methods. Accordingly, severalnon-invasive markers have been evaluated for thediagnosis of simple steatosis and NASH, including bothserological indices and imaging methods. The presentreview summarizes the current knowledge on the roleof these markers in the diagnosis of NAFLD. Currentdata suggest that ultrasound and the fibrosis-4 scoreare probably the most appealing methods for detectingsteatosis and for distinguishing NASH from simplesteatosis, respectively, because of their low cost andrelatively high accuracy. However, currently availablemethods, both serologic and imaging, cannot obviatethe need for liver biopsy for diagnosing NASH dueto their substantial false positive and false negativerates. Therefore, the current role of these methods isprobably limited in patients who are unwilling or havecontraindications for undergoing biopsy.
