肝纤维化和肝硬化的非侵袭性评估

Hong You*. Liver Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China

Fibrosis is a frequent, life-threatening complication of most chronic liver diseases. Up to now liver biopsy is still the gold standard for assessment of hepatic fibrosis and cirrhosis. However, it is invasive with possible complications, costly and afflicted with a high degree of sampling error. There is a strong demand for reliable, liver specific, non-invasive biomarkers of fibrosis and cirrhosis to replace or to complement the invasivemethod of needle biopsy. Class I biomarkers are defined as serum components which reflect ECM turnover (fibrogenesis and fibrolysis) and fibrogenic cell changes, mainly of hepatic stellate cells, which are the dominant profibrogenic cell type in liver. The development of hepatic fibrosis or cirrhosis is due to increased synthesis, deposition, and possibly reduced degradation of hepatic extracellular matrix components, especially collagens, such as interstitial type I and III, basement membrane type IV, microfibrillar type VI, and pericellular type V, non-collagenous proteins, such as laminin, fibronectin, undulin, etc. Class II biomarkers comprise in general rather simple standard laboratory tests, which are grouped into panels. Class II biomarkers are based on algorithmic evaluation of commonly observed functional alterations of the liver that do not necessarily reflect ECM metabolism and/or fibrogenic cell changes. About 20 numerical scores or indices are reported for parameters, which are mostly routine laboratory tests and frequently multiparametric (panels). They fulfil most criteria for detection and staging of fibrosis and to a lesser extent grading of fibrogenic activity. The Fibrotest is the most investigated combination of serum markers for fibrosis. However, the diagnostic use of many of these scores is still limited and standardization of the assays is only partially realized. Transient elastography (Fibroscan), which measures the stiffness of the liver by means of ultrasound as a measure of fibrosis and cirrhosis, is simple to perform and the inter- and intra-observer variability is small. The accuracy is high in discriminating between cirrhosis and fibrosis, but lower for discriminating between the different stages of fibrosis in both chronic hepatitis B and C. All the makers of liver fibrosis can be combined for a better diagnosis.