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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis
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Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

机译：非酒精性脂肪肝疾病，非酒精性脂肪性肝炎和相关纤维化的诊断方式

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Nonalcoholic fatty liver disease (NAFLD) is a spectrum comprised of isolated steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. The majority of NAFLD subjects do not have NASH and do not carry a significant risk for liver‐related adverse outcomes (cirrhosis and mortality). Globally, the prevalence of NAFLD is approximately 25%. In Asia, a gradient of high to low prevalence rates is noted from urban to rural areas. Given the prevalence of NAFLD, the clinical and economic burden of NAFLD and NASH can be substantial. With increasing recognition of NASH as an important liver disease, the diagnosis of NASH still requires a liver biopsy that is suboptimal. Although liver biopsy is the most accurate modality to diagnose and stage the severity of NASH, this method suffers from being invasive, costly, associated with potential complications, and plagued with interobserver variability of individual pathological features. A number of noninvasive modalities to diagnose NASH and stage liver fibrosis are being developed. These modalities include predictive models (NAFLD fibrosis score) and serum biomarkers such as enhanced liver fibrosis (ELF). Other tests are based on radiological techniques, such as transient elastography (TE) or magnetic resonance elastography (MRE), which are used to estimate liver stiffness as a potential surrogate of hepatic fibrosis. Although a dynamic field of research, most of these diagnostic modalities have area under the curve ranging between 0.76 and 0.90%, with MRE having the best predictive performance. In summary, developing safe and easily accessible noninvasive modalities to accurately diagnose and monitor NASH and associated fibrosis is of utmost importance in clinical practice and clinical research. These tests are not only important to risk stratify subjects at the greatest risk for progressive liver disease, but also to serve as appropriate surrogate endpoints for therapeutic clinical trials of NASH. (H epatology 2018;68:349‐360).
机译：非酒精性脂肪肝疾病（NAFLD）是一种由孤立的脂肪变性，非酒精性脂肪疏皮性（NASH），晚期纤维化和肝硬化组成的光谱。大多数NAFLD受试者没有纳什并且对肝相关的不利结果（肝硬化和死亡率）造成显着风险。在全球范围内，NAFLD的患病率约为25％。在亚洲，从城市到农村地区都指出了高度低于普及率的梯度。鉴于NAFLD的患病率，NAFLD和NASH的临床和经济负担可能很大。随着纳什作为重要肝病的识别，纳什的诊断仍需要肝脏活组织检查，这是次优。虽然肝活检是诊断和纳什严重程度的最准确的模态，但这种方法患有侵入性，昂贵，与潜在的并发症相关，并困扰各种病理特征的interobserver变异性。正在开发许多用于诊断肿瘤和阶段肝纤维化的非侵入式模态。这些方式包括预测模型（NAFLD纤维化评分）和血清生物标志物，例如增强肝纤维化（ELF）。其他测试基于放射技术，例如瞬态弹性摄影（TE）或磁共振弹性成像（MRE），其用于估计肝硬化作为肝纤维化的潜在替代。虽然具有动态研究领域，但大多数这些诊断方式都有在曲线下的区域，范围为0.76％和0.90％，MRE具有最佳的预测性能。总之，开发安全易于无障碍的非侵入式型号，以准确诊断和监测肿瘤和相关纤维化在临床实践和临床研究中至关重要。这些测试不仅重要的是在进步性肝病的最大风险中冒着分层受试者的重要性，而且还可以作为纳什治疗性临床试验的适当替代终点。 （2018年Hopatology; 68：349-360）。

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