非酒精性脂肪性肝炎无创诊断的研究进展

杨硕; 吕栋; 徐有青

doi:10.3969/j.issn.1001-5256.2013.12.007

非酒精性脂肪性肝炎无创诊断的研究进展

DOI: 10.3969/j.issn.1001-5256.2013.12.007

首都医科大学附属北京天坛医院消化内科

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中图分类号: R575.1
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出版历程
- 收稿日期: 2013-07-31
- 出版日期: 2013-12-20

Research advances in noninvasive diagnosis of nonalcoholic steatohepatitis

Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University

摘要

摘要: 非酒精性脂肪性肝炎（NASH）是非酒精性脂肪性肝病进展过程中的关键阶段。目前肝组织活检是诊断NASH的金标准,但此项检查因为有创伤、有风险等缺点而不能被广泛接受,故寻找特异性和敏感性均相对较高的NASH无创诊断方法是当前研究的热点之一。总结与NASH无创诊断密切相关的CK-18、转化生长因子β1、AST/血小板比值等血清学检查及超声、瞬时弹性成像、磁共振弹性成像等影像学检查,发现每种检查方法各有利弊,但也提示联合应用2种或2种以上的检查方法可能成为日后NASH无创诊断的研究方向。
- 脂肪肝 /
- 血清学试验 /
- 诊断显像
Abstract: Nonalcoholic steatohepatitis ( NASH) is a key stage in the progression of nonalcoholic fatty liver disease. Now liver biopsy is the gold standard for diagnosing NASH, but it cannot be widely used due to its invasiveness and potential hazards. Therefore, searching for noninvasive diagnostic methods for NASH with relatively high sensitivity and specificity is a hotspot of current research. The examination methods closely related to noninvasive diagnosis of NASH, such as serological tests for CK-18, TGF-β1, APRI, etc. and imaging examinations including ultrasound, TE, and MRE, are summarized. It is found that each method has advantages and disadvantages, suggesting that joint use of two or more examination methods may be the research direction for noninvasive diagnosis of NASH.
- fatty liver /
- serology tests /
- diagnostic imaging

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参考文献(31)

[1]CHALASANI N, YOUNOSSI Z, LAVINE JE, et al.The Diagnosis and management of non-alcoholic fatty liver disease:practice guideline by the American Gastroenterological Association, American Association for the study of liver diseases, and American College of Gastroenterology[J].Gastroenterology, 2012, 142 (7) :1592-1609.

[2]ALKHOURI N, CARTER-KENT C, FELDSTEIN AE.Apoptosis in nonalcoholic fatty liver disease:diagnostic and therapeutic implications[J].Expert Rev Gastroenterol Hepatol, 2011, 5 (2) :201-212.

[3]JOKA D, WAHL K, MOELLER S, et al.Prospective biopsy-controlled evaluation of cell death biomarkers for prediction of liver fibrosis and nonalcoholic steatohepatitis[J].Hepatology, 2012, 55 (2) :455-464.

[4]FELDSTEIN AE, WIECKOWSKA A, LOPEZ AR, et al.Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis:a multicenter validation study[J].Hepatology, 2009, 50 (4) :1072-1078.

[5]CHEN J, ZHU Y, ZHENG Q, et al.Serum cytokeratin-18 in the diagnosis of non-alcoholic steatohepatitis:A meta-analysis[J].Hepatol Res, 2013, Jul 9.[Epub ahead of print]

[6]DIAB DL, YERIAN L, SCHAUER P, et al.Cytokeratin 18 fragment levels as a noninvasive biomarker for nonalcoholic steatohepatitis in bariatric surgery patients[J].Clin Gastroenterol Hepatol, 2008, 6 (11) :1249-1254.

[7]HASEGAWA T, YONEDA M, NAKAMURA K.Plasma transforming growth factor-beta1 level and efficacy of alpha-tocopherol in patients with non-alcoholic steatohepatitis:A pilot study[J].Aliment Pharmacol Ther, 2001, 15 (10) :1667-1672.

[8]ADEL AM, AMAL SB, SHERIF SS.Serum TGF-β, serum MMP-1, and HOMA-IR as non-invasive predictors of fibrosis in Egyptian patients with NAFLD[J].Saudi J Gastroenterol, 2012, 18 (5) :327-333.

[9]FUJII H, ENOMOTO M, FUKUSHIMA W, et al.Noninvasive laboratory tests proposed for predicting cirrhosis in patients with chronic hepatitis C are also useful in patients with non-alcoholic steatohepatitis[J].J Gastroenterol, 2009, 44 (6) :608-614.

[10]KRUGER FC, DANIELS CR, KIDD M, et al.APRI:a simple bedside marker for advanced fibrosis that can avoid liver biopsy in patients with NAFLD/NASH[J].S Afr Med J, 2011, 101 (7) :477-480.

[11]NANNIPIERI M, CECCHETTI F, ANSELMINO M, et al.Pattern of expression of adiponectin receptors in human liver and its relation to nonalcoholic steatohepatitis[J].Obes Surg, 2009, 19 (4) :467-474.

[12]TSOCHATZIS EA, PAPATHEODORIDIS GV, ARCHIMANDRITIS AJ.Adipokines in nonalcoholic steatohepatitis:from pathogenesis to implications in diagnosis and therapy[J].Mediators Inflamm, 2009, 2009:831670.

[13]TAMIMI TI, ELGOUHARI HM, ALKHOURI N, et al.An apoptosis panel for nonalcoholic steatohepatitis diagnosis[J].J Hepatol, 2011, 54 (6) :1224-1229.

[14]RYAN CK, JOHNSON LA, GERMIN BI, et al.One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation[J].Liver Transpl, 2002, 8 (12) :1114-1122.

[15]MOTTIN CC, MORETTO M, PADOIN AV, et al.The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients[J].Obes Surg, 2004, 14 (5) :635-637.

[16]SANYAL AJ.AGA technical review on nonalcoholic fatty liver disease[J].Gastroenterology, 2002, 123 (5) :1705-1725.

[17]IIJIMA H, MORIYASU F, TSUCHIYA K, et al.Decrease in accumulation of ultrasound contrast microbubbles in non-alcoholic steatohepatitis[J].Hepatol Res, 2007, 37 (9) :722-730.

[18]DAVIDSON LE, KUK JL, CHURCH TS, et al.Protocol for measurement of liver fat by computed tomography[J].J Appl Physiol, 2006, 100 (3) :864-868.

[19]PARK SH, KIM PN, KIM KW, et al.Macrovesicular hepatic steatosis in living liver donors:use of CT for quantitative and qualitative assessment[J].Radiology, 2006, 239 (1) :105-112.

[20]MAZHAR SM, SHIEHMORTEZA M, SIRLIN CB.Noninvasive assessment of hepatic steatosis[J].Clin Gastroenterol Hepatol, 2009, 7 (2) :135-140.

[21]ANDERSEN E, CHRISTENSEN P, WEIS N.Transient elastography for liver fibrosis diagnosis[J].Eur J Intern Med, 2009, 20 (4) :339-342.

[22]WANG YJ, TANG SS.Assessment of hepatic fibrosis stage by transient elastography:An Meta-analysis[J].Chin J Med Imaging Technol, 2012, 28 (3) :529-533. (in Chinese) 王一娇, 唐少珊.瞬时弹性成像评价肝纤维化分级的Meta分析[J].中国医学影像技术, 2012, 28 (3) :529-533.

[23]KUMAR R, RASTOGI A, SHARMA MK, et al.Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease:diagnostic performance and clinicopathological correlation[J].Dig Dis Sci, 2013, 58 (1) :265-274.

[24]MYERS RP, POMIER-LAYRARGUES G, KIRSCH R, et al.Discordance in fibrosis staging between liver biopsy and transient elastography using the FibroScan XL probe[J].J Hepatol, 2012, 56 (3) :564-570.

[25]SHEN F, XU ZJ, PAN Q, et al.Influencing factors and reproducibility of controlled attenuation parameters in the evaluation of fatty liver disease using FibroScan[J].J Clin Hepatol, 2013, 16 (1) :59-62. (in Chinese) 沈峰, 徐正婕, 潘勤, 等.FibroScan实施受控衰减参数评价脂肪肝的影响因素及重复性分析[J].实用肝脏病杂志, 2013, 16 (1) :59-62.

[26]LDINGHEN VD, WONG VW-S, VERGNIOL J, et al.Diagnosis of liver fibrosis and cirrhosis using liver stiffness measurement:Comparison between M and XL probe of FibroScan[J].J Hepatol, 2012, 56 (4) :833-839.

[27]MARIAPPAN YK, GLASER KJ, EHMAN RL.Magnetic resonance elastography:a review[J].Clin Anat, 2010, 23 (5) :497-511.

[28]SHI Y, GUO QY, ZHANG L, et al.Magnetic resonance elastography for liver sitffness in healthy volunteers at 3.0T MR scanner[J].Chin J Med Imaging Technol, 2013, 29 (6) :941-944. (in Chinese) 石喻, 郭启勇, 张兰, 等.正常人肝脏3.0T磁共振弹性成像[J].中国医学影像技术, 2013, 29 (6) :941-944.

[29]HUWART L, SEMPOUX C, VICAUT E, et al.Magnetic resonance elastography for the noninvasive staging of liver fibrosis[J].Gastroenterology, 2008, 135 (1) :32-40.

[30]KIM BH, LEE JM, LEE YJ, et al.MR elastography for noninvasive assessment of hepatic fibrosis:experience from a tertiary center in Asia[J].J Magn Reson Imaging, 2011, 34 (5) :1110-1116.

[31]CHEN J, TALWALKAR JA, YIN M, et al.Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography[J].Radiology, 2011, 259 (3) :749-756.

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