中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

进展性非酒精性脂肪性肝病的无创诊断方法

龚航 李良平

引用本文:
Citation:

进展性非酒精性脂肪性肝病的无创诊断方法

DOI: 10.3969/j.issn.1001-5256.2019.02.038
详细信息
  • 中图分类号: R575.5

Noninvasive diagnosis of progressive nonalcoholic fatty liver disease

  • 摘要: 非酒精性脂肪性肝病(NAFLD)的特点是其以肝细胞脂肪变性和脂肪贮积为病理特征,其肝脏组织病理的演变从单纯的肝脂肪变性到肝细胞损伤的脂肪性肝炎,最终发展为肝纤维化和肝硬化,甚至肝癌。由于NAFLD与代谢综合征、结直肠肿瘤密切相关,甚至可以导致残疾、死亡,故早期诊断非酒精性脂肪性肝炎,明确肝纤维化程度尤为重要。其中肝活组织检查作为诊断NAFLD肝脏组织病理学分级、分期的金标准,一直在肝纤维化诊断中占据主要位置,但由于肝活组织检查的局限性促使近年来无创诊断技术迅速发展。单独的血清学模型、影像学检查诊断非酒精性脂肪性肝炎、早期肝纤维化的敏感度、特异度尚待提高。主要就进展性NAFLD的联合无创诊断方法进展作一综述。

     

  • [1]BORAI IH, SHAKER Y, KAMAL MM, et al.Evaluation of biomarkers in Egyptian patients with different grades of nonalcoholic fatty liver disease[J].J Clin Transl Hepatol, 2017, 5 (2) :109-118.
    [2]OFOSU A, RAMAI D, REDDY M, et al.Non-alcoholic fatty liver disease:Controlling an emerging epidemic, challenges, and future directions[J].Ann Gastroenterol, 2018, 31 (3) :288-295.
    [3]European Association for the Study of the Liver (EASL) , European Association for the Study of Diabetes (EASD) , European Association for the Study of Obesity (EASO) .EASL-EASD-EASO clinical practice guidelines for the management of nonalcoholic fatty liver disease[J].J Hepatol, 2016, 64 (6) :1388-1402.
    [4]DIEHL AM, DAY C.Cause, pathogenesis, and treatment of nonalcoholic steatohepatitis[J].N Engl J Med, 2017, 377 (21) :2063-2072.
    [5]HE L, DENG L, ZHANG Q, et al.Diagnostic value of CK-18, FGF-21, and related biomarker panel in nonalcoholic fatty liver disease:A systematic review and meta-analysis[J].Biomed Res Int, 2017, 2017:9729107.
    [6]OKANOUE T, EBISE H, KAI T, et al.A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis[J].J Gastroenterol, 2018, 53 (1) :129-139.
    [7]YONEDA M, MAWATARI H, FUJITA K, et al.High-sensitivity C-reactive protein is an independent clinical feature of nonalcoholic steatohepatitis (NASH) and also of the severity of fibrosis in NASH[J].J Gastroenterol, 2007, 42 (7) :573-582.
    [8]ZHANG DK, CHEN M, LIU Y, et al.The diagnostic value of ARFI imaging and APRI for quantitative evaluating the degree of liver fibrosis in NAFLD patients[J].J Chin Clin Med Imaging, 2013, 24 (3) :178-181. (in Chinese) 张大鹍, 陈敏, 刘阳, 等.ARFI与APRI指数对非酒精性脂肪性肝病肝纤维化的诊断价值[J].中国临床医学影像杂志, 2013, 24 (3) :178-181.
    [9]AYKUT UE, AKYUZ U, YESIL A, et al.A comparison of FibroMeterTMNAFLD Score, NAFLD fibrosis score, and transient elastography as noninvasive diagnostic tools for hepatic fibrosis in patients with biopsy-proven non-alcoholic fatty liver disease[J].Scand J Gastroenterol, 2014, 49 (11) :1343-1348.
    [10]SUN W, CUI H, LI N, et al.Comparison of FIB-4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease:A meta-analysis study[J].Hepatol Res, 2016, 46 (9) :862-870.
    [11]GUO ZQ, WANG QY, QI XS, et al.Recommendations for the diagnosis and management of nonalcoholic fatty liver disease:Practice guidance from the American Association for the Study of Liver Diseases (2017) [J].J Clin Hepatol, 2017, 33 (12) :2275-2277. (in Chinese) 郭泽淇, 王倩怡, 祁兴顺, 等.《2017年美国肝病学会非酒精性脂肪性肝病诊疗指导》摘译[J].临床肝胆病杂志, 2017, 33 (12) :2275-2277.
    [12]National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association;Fatty Liver Expert Committee, Chinese Medical Doctor Association.Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J].J Clin Hepatol, 2018, 34 (5) :947-957. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南 (2018年更新版) [J].临床肝胆病杂志, 2018, 34 (5) :947-957.
    [13]CHANG XX, YAN HM, ZHANG LS, et al.Comparison of different non-invasive hepatic fibrosis evaluation criteria for the evaluation of hepatic fibrosis in patients with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease[J].Chin J Clin Med, 2015, 22 (2) :130-134. (in Chinese) 常薪霞, 颜红梅, 张林杉, 等.不同无创肝纤维化评分指标评估2型糖尿病伴非酒精性脂肪肝病患者肝纤维化的比较[J].中国临床医学, 2015, 22 (2) :130-134.
    [14]DONG CF, LIU YX, LI HY, et al.Quantitative diagnosis of nonalcoholic simple fatty liver by sound speed correction[J/CD].Chin J Liver Dis:Electr Version, 2017, 9 (1) :32-35. (in Chinese) 董常峰, 刘映霞, 李汉英, 等.声速匹配技术定量诊断非酒精性单纯性脂肪肝[J/CD].中国肝脏病杂志:电子版, 2017, 9 (1) :32-35.
    [15]European Association for the Study of the Liver, Asociacion Latinoamericana para el Estudio del Higado.EASL-ALEHclinical practice guidelines:Non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol, 2015, 63 (1) :237-264.
    [16]MAO ZS, NING HB, HE J, et al.The value of FibroTouch fat attenuation parameter in patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease[J].Chin J Infect Dis, 2015, 33 (6) :339-342. (in Chinese) 毛重山, 宁会彬, 何佳, 等.FibroTouch脂肪衰减参数在慢性乙型肝炎合并非酒精性脂肪肝患者中的应用价值[J].中华传染病杂志, 2015, 33 (6) :339-342.
    [17]PETTA S, WONG VW, CAMMC, et al.Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values[J].Hepatology, 2017, 65 (4) :1145-1155.
    [18]IMAJO K, KESSOKU T, HONDA Y, et al.Magnetic resonance imaging more accurately classifies steatosis and fibrosis in patients with nonalcoholic fatty liver disease than transient elastography[J].Gastroenterology, 2016, 150 (3) :626-637.
    [19]WONG VW, VERGNIOL J, WONG GL, et al.Liver stiffness measurement using XL probe in patients with nonalcoholic fatty liver disease[J].Am J Gastroenterol, 2012, 107 (12) :1862-1871.
    [20]XIAO G, ZHU S, XIAO X, et al.Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease:Ameta-analysis[J].Hepatology, 2017, 66 (5) :1486-1501.
    [21]FERRAIOLI G, TINELLI C, DAL BELLO B, et al.Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C:A pilot study[J].Hepatology, 2012, 56 (6) :2125-2133.
    [22]TAKEUCHI H, SUGIMOTO K, OSHIRO H, et al.Liver fibrosis:Noninvasive assessment using supersonic shear imaging and FIB4 index in patients with non-alcoholic fatty liver disease[J].J Med Ultrason, 2018, 45 (2) :243-249.
    [23]DAI Q, LI JJ, MA SS, et al.Diagnostic value of transient elastography (FibroTouch) combined with APRI and FIB-4 on liver fibrosis in patients with chronic hepatitis B[J].Acta Univ Med Anhui, 2017, 52 (3) :430-434. (in Chinese) 代倩, 李晶晶, 马双双, 等.瞬时弹性成像联合APRI和FIB-4指数模型无创诊断慢性HBV感染者肝纤维化的临床价值[J].安徽医科大学学报, 2017, 52 (3) :430-434.
    [24]ZHANG YL, MA YJ, WANG ZL, et al.Evaluation of four scoring systems in diagnosis of hepatic fibrosis in patients with nonalcoholic fatty liver disease[J].China J Modern Med, 2017, 27 (22) :112-116. (in Chinese) 张意兰, 马英杰, 王志凌, 等.4种评分系统在非酒精性脂肪肝病肝纤维化程度的诊断效能评价[J].中国现代医学杂志, 2017, 27 (22) :112-116.
    [25]PETTA S, VANNI E, BUGIANESI E, et al.The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease[J].Liver Int, 2015, 35 (5) :1566-1573.
    [26]CHAN WK, NIK MUSTAPHA NR, MAHADEVA S.A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis[J].Hepatol Int, 2015, 9 (4) :594-602.
    [27]BOURSIER J, VERGNIOL J, SAWADOGO A, et al.The combination of a blood test and Fibroscan improves the non-invasive diagnosis of liver fibrosis[J].Liver Int, 2009, 29 (10) :1507-1515.
    [28]ZHANG X, WANG Y, MA J, et al.Value of five noninvasive diagnostic techniques and their combinations in diagnosis of liver fibrosis in patients with chronic hepatitis B[J].J Clin Hepatol, 2016, 32 (10) :1888-1893. (in Chinese) 张旭, 王煜, 马娟, 等.5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较[J].临床肝胆病杂志, 2016, 32 (10) :1888-1893.
    [29]ALKHOURI N, SEDKI E, ALISI A, et al.Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease[J].Liver Int, 2013, 33 (1) :79-85.
  • 加载中
计量
  • 文章访问数:  1843
  • HTML全文浏览量:  54
  • PDF下载量:  344
  • 被引次数: 0
出版历程
  • 收稿日期:  2018-08-21
  • 出版日期:  2019-02-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回