肝组织学评估在非酒精性脂肪性肝病临床研究及实践中的作用

蒋丽娜; 赵景民

doi:10.3969/j.issn.1001-5256.2017.12.009

肝组织学评估在非酒精性脂肪性肝病临床研究及实践中的作用

DOI: 10.3969/j.issn.1001-5256.2017.12.009

解放军第三〇二医院病理诊断与研究中心

基金项目:

首都卫生发展科研专项项目(首发2014-2-5032)；国家自然科学基金青年项目(81500450);国家自然科学基金面上项目(81673654)；

详细信息

中图分类号: R575.5
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出版历程
- 出版日期: 2017-12-20

Role of histological evaluation of the liver in clinical practice and research on nonalcoholic fatty liver disease

Research funding:

摘要

摘要: 肝活组织检查是非酒精性脂肪性肝病(NAFLD),尤其是非酒精性脂肪性肝炎(NASH)诊断的"金标准",尽管肝穿刺检查存在有创性、取样和评价误差等局限性,但在NAFLD/NASH临床试验研究及新药临床试验中,肝组织学评价是研究队列患者入组、主要治疗终点和(或)次要治疗终点评价的主要评价指标,具有其他方法目前尚不可替代的作用。NAFLD/NASH的组织学评价系统主要包括Brunt系统、美国NASH临床研究网络评分系统、欧洲SAF/FLIP评分系统和儿童NAFLD组织学评分系统,在临床实践和研究中应选择适合的组织学评分系统。
- 非酒精性脂肪性肝病 /
- 活组织检查,针吸 /
- 评价研究
Abstract: Liver biopsy is currently the gold standard for the diagnosis of nonalcoholic fatty liver disease ( NAFLD) , especially nonalcoholic steatohepatitis ( NASH) . Although liver biopsy has the limitations such as invasiveness, sampling error, and evaluation error, in clinical trials of NAFLD/NASH and related new drugs, it is still used to evaluate the enrollment of patients into a cohort and primary and/or secondary endpoints and cannot be replaced by other methods. The histological evaluation systems of NAFLD/NASH mainly include Brunt system, NASH-CRN scoring system, European SAF/FLIP scoring algorithm, and pediatric NAFLD histological scoring system, and an appropriate histological scoring system should be selected in clinical practice and research.
- nonalcoholic fatty liver disease /
- biopsy /
- needle

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参考文献(29)

[1]ROMERO-GMEZ M, ZELBER-SAGI S, TRENELL M.Treatment of NAFLD with diet, physical activity and exercise[J].J Hepatol, 2017, 67 (4) :829-846.

[2]YOUNOSSI Z, ANSTEE QM, MARIETTI M, et al.Global burden of NAFLD and NASH:trends, predictions, risk factors and prevention[J].Nat Rev Gastroenterol Hepatol, 2017.[Epub ahead of print]

[3]FAN JG, KIM SU, WONG VW.New trends on obesity and NAFLDin Asia[J].J Hepatol, 2017, 67 (4) :862-873.

[4]GU D, REYNOLDS K, WU X, et.al.Prevalence of the metabolic syndrome and overweight among adults in China[J].Lancet, 2005, 365 (9468) :1398-1405.

[5]FARRELL GC, LARTER CZ.Nonalcoholic fatty liver disease:from steatosis to cirrhosis[J].Hepatology, 2006, 43 (2 Suppl 1) :s99-s112.

[6]DOULBERIS M, KOTRONIS G, GIALAMPRINOU D, et al.Non-alcoholic fatty liver disease:an update with special focus on the role of gut microbiota[J].Metabolism, 2017, 71:182-197.

[7]DEGASPERI E, COLOMBO M.Distinctive features of hepatocellular carcinoma in non-alcoholic fatty liver disease[J].Lancet Gastroenterol Hepatol, 2016, 1 (2) :156-164.

[8]WONG VW, CHITTURI S, WONG GL, et al.Pathogenesis and novel treatment options for non-alcoholic steatohepatitis[J].Lancet Gastroenterol Hepatol, 2016, 1 (1) :56-67.

[9] DULAI PS, SINGH S, PATEL J, et al.Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease:Systematic review and meta-analysis[J].Hepatology, 2017, 65 (5) :1557-1565.

[10]WESOLOWSKI SR, KASMI KC, JONSCHER KR, et al.Developmental origins of NAFLD:a womb with a clue[J].Nat Rev Gastroenterol Hepatol, 2017, 14 (2) :81-96.

[11]TILG H, MOSCHEN AR, RODEN M.NAFLD and diabetes mellitus[J].Nat Rev Gastroenterol Hepatol, 2017, 14 (1) :32-42.

[12]ADAMS LA, ANSTEE QM, TILG H, et.al.Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases[J].Gut, 2017, 66 (6) :1138-1153.

[13]CHALASANI N, YOUNOSSI Z, LAVINE JE, et al.The diagnosis and management of nonalcoholic fatty liver disease:practice guidance from the American Association for the Study of Liver Diseases[J].Hepatology, 2017.[Epub ahead of print]

[14]European Association for the Study of the Liver (EASL) , EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease[J].J Hepatol, 2016, 64 (6) :1388-1402.

[15]DOYCHEVA I, WATT KD, ALKHOURI N.Nonalcoholic fatty liver disease in adolescents and young adults:the next frontier in the epidemic[J].Hepatology, 2017, 65 (6) :2100-2109.

[16]FAN JG, CHITTURI S.Hepatitis B and fatty liver:causal or coincidental?[J].J Gastroenterol Hepatol, 2008, 3 (5) :679-681.

[17]LIEW PL, LEE WJ, LEE YC, et al.Hepatic histopathology of morbid obesity:concurrence of other forms of chronic liver disease[J].Obes Surg, 2006, 16 (12) :1584-1593.

[18]SHI JP, FAN JG, WU R, et al.Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection[J].J Gastroenterol Hepatol, 2008, 23 (9) :1419-1425.

[19]MACHADO MV, OLIVEIRA AG, CORTEZ-PINTO H.Hepatic steatosis in hepatitis B virus infected patients:meta-analysis of risk factors and comparison with hepatitis C infected patients[J].JGastroenterol Hepatol, 2011, 26 (9) :1361-1367.

[20]JOO EJ, CHANG Y, YEOM JS, et al.Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease:a cohort study[J].Hepatology, 2017, 65 (3) :828-835.

[21]BRUNT EM, JANNEY CG, di BISCEGLIE AM, et al.Nonalcoholic steatohepatitis:a proposal for grading and staging the histological lesions[J].Am J Gastroenterol, 1999, 94 (9) :2467-2474.

[22]KLEINER DE, BRUNT EM, van NATTA M, et al.Design and validation of a histological scoring system for nonalcoholic fatty liver disease.Nonalcoholic Steatohepatitis Clinical Research Network[J].Hepatology, 2005, 41 (6) :1313-1321.

[23]BEDOSSA P, FLIP Pathology Consortium.Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease[J].Hepatology, 2014, 60 (2) :565-575.

[24]BEDOSSA P, POITOU C, VEYRIE N, et al.Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients[J].Hepatology, 2012, 56 (5) :1751-1759.

[25]ALKHOURI N, de VITO R, ALISI A, et al.Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease[J].J Hepatol, 2012, 57 (6) :1312-1318.

[26]RATZIU V, HARRISON SA, FRANCQUE S, et al.Elafibranor, an agonist of the peroxisome proliferator-activated receptor-αand-δ, induces resolution of nonalcoholic steatohepatitis without fibrosis worsening[J].Gastroenterology, 2016, 150 (5) :1147-1159.

[27]NEUSCHWANDER-TETRI BA, LOOMBA R, SANYAL AJ, et al.Farnesoid X nuclear receptor ligand obeticholic acid for noncirrhotic, non-alcoholic steatohepatitis (FLINT) :a multicentre, randomised, placebo-controlled trial[J].Lancet, 2015, 385 (9972) :956-965.

[28]ROTMAN Y, SANYAL AJ.Current and upcoming pharmacotherapy for non-alcoholic fatty liver disease[J].Gut, 2017, 66 (1) :180-190.

[29]VIOLI F, CANGEMI R.Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis[J].N Engl J Med, 2010, 363 (12) :1185-1186.

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