Diagnosis of cirrhosis and portal hypertension:imaging,non-invasive markers of fibrosis and liver biopsy

肝硬化和门脉高压的诊断:影像学、非侵入性纤维化标志物和肝脏活检

The concept of‘cirrhosis’is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of prognosis.Furthermore,the term‘advanced chronic liver disease(ACLD)’better reflects the continuum of histological changes occurring in the liver,which continue to progress even after cirrhosis has developed,and might regress after removing the etiological factor causing the liver disease.In compensated ACLD,portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and treatment.Invasive tests to diagnose cirrhosis(liver biopsy)and portal hypertension(hepatic venous pressure gradient measurement and endoscopy)remain of crucial importance in several difficult clinical scenarios,but their need can be reduced by using different non-invasive tests in standard cases.Among non-invasive tests,the accepted use,major limitations and major benefits of serum markers of fibrosis,elastography and imaging methods are summarized in the present review.

肝硬化的概念一直在不断演进,现在已经明确的是,代偿期与失代偿期肝硬化预后是完全不同的。进展期慢性肝病(ACLD)这一称谓能更好地反应肝脏组织学变化的进程,比如,即使肝硬化形成了,肝脏组织学仍会继续进展;而在去除病因后,肝脏也可能会在组织学上逆向转好。对于代偿期ACLD,门脉高压标志着疾病进展到了一个并发症高危期,需要准确评估和治疗。在一些复杂的临床情况下,用以诊断肝硬化(肝脏活检)和门脉高压(肝静脉压力梯度检测)等侵入性检查仍然是至关重要的,但由于各种非侵入性检查方法在常规病例中的广泛应用,侵入性检查的临床需求已大大降低。本文对纤维化标志物、弹性成像和影像学等非侵入性检查方法的应用情况、主要优缺点进行了综述。