肝纤维化逆转:更多证据 更多挑战

Reversal of hepatic fibrosis:more evidence and more challenges

肝纤维化是肝脏对损伤的一种修复反应, 如持续进展就会导致肝硬化及其并发症。近年来发现病毒性肝炎、非酒精性脂肪性肝炎、酒精性肝病、自身免疫性肝病等, 在控制病因后肝纤维化甚至肝硬化均可以逆转。逆转的评价金标准仍是肝活检, 瞬时弹性成像等无创指标用于动态监测, 有很好的前景。逆转的机制包括细胞外基质的降解、肝细胞再生及血管重构等。目前需针对肝纤维化关键靶点的治疗药物。

Hepatic fibrosis is a response to various types of hepatic injury,which can lead to cirrhosis and its complications.In recent years,in patients with viral hepatitis,nonalcoholic steatohepatitis,alcoholic liver discase,autoimmune liver disease and others the fibrosis or even early cirrhosis can be regressed if the etiology are controlled.Liver biopsy is still the gold standard for assessing fibrosis reversal,but non-invasive methods such as transient elastography hold great promise due to the ease to use for dynamic monitoring.Mechanisms of hepatic fibrosis reversal include extracellular matrix degradation,hepatocyte regeneration,and vascular remodeling.Presently,novel agents targeting the steps of fbrosis are urgently need for achieving regression of liver fibrosis.