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纤维化非酒精性脂肪性肝炎无创诊断的研究进展
DOI: 10.12449/JCH241125
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：冯巩、孔荣耀、王嘉学、吴天悦负责课题设计，撰写论文；冯巩、王菊宁、孔荣耀、严琴琴、武晓慧负责论文的资料收集，资料分析和合作协调；冯巩、弥曼负责拟定写作思路，指导撰写文章并最后定稿。
Research advances of noninvasive diagnosis of fibrotic non-alcoholic steatohepatitis
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摘要: 非酒精性脂肪性肝病（NAFLD）患者中有一部分可发展为非酒精性脂肪性肝炎（NASH），当NASH的纤维化程度F≥2且NAFLD活动度评分≥4时，该阶段的NASH被称为纤维化NASH，是药物临床试验中的重点关注对象。目前肝组织活检是评估肝组织学变化的金标准，但因其有创性限制了临床上的应用，因此开发纤维化NASH的非侵入性检测方法显得尤为重要。本文总结了近年来针对纤维化NASH的新型无创诊断方法的相关研究成果，阐述了新型诊断方法对纤维化NASH预测的现状、面临的挑战和未来的发展前景。Abstract: A subset of patients with non-alcoholic fatty liver disease （NAFLD） can progress to nonalcoholic steatohepatitis （NASH）. When NASH reaches a fibrosis degree of F≥2 and a NAS score of≥4， this stage of NASH is referred to as fibrotic NASH， which is a key focus in clinical drug trials. Currently， liver biopsy is the gold standard for assessing the histological changes of the liver， but its clinical application is limited by its invasiveness， and therefore， it is of particular importance to develop noninvasive detection methods for fibrotic NASH. This article summarizes the recent research achievements in novel noninvasive diagnostic methods for fibrotic NASH and elaborates on these new diagnostic methods for predicting fibrotic NASH in terms of current status， challenges faced， and prospects for future development.
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Key words:
- Non-alcoholic Fatty Liver Disease /
- Fibrosis /
- Biomarkers /
- Diagnosis /
- Artificial Intelligence
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表 1 AI辅助模型的临床参数及性能
Table 1. Clinical parameters and performance of AI-assisted models
AI辅助模型 性能 敏感度 特异度 阳性预测值 阴性预测值 ANN和CNN 诊断NAFLD 0.97（95%CI：0.76～1.00） 0.91（95%CI：0.78～0.97） 0.95（95%CI：0.87～0.98） 0.93（95%CI：0.80～0.98） AI辅助超声波检查 诊断NAFLD 0.97（95%CI：0.91～0.99） 0.98（95%CI：0.89～1.00） 0.98（95%CI：0.93～1.00） 0.95（95%CI：0.88～0.98） AI辅助临床数据 诊断NAFLD 0.75（95%CI：0.66～0.82） 0.82（95%CI：0.74～0.88） 0.75（95%CI：0.60～0.86） 0.82（95%CI：0.74～0.87） AI辅助超声检查、弹性成像、CT、MRI以及诊断肝纤维化和脂肪变性 诊断肝硬化 0.78（95%CI：0.71～0.85） 0.89（95%CI：0.81～0.94） 0.72（95%CI：0.58～0.83） 0.92 （95%CI：0.88～0.94） 诊断进展性纤维化 0.86（95%CI：0.80～0.90） 0.87（95%CI：0.80～0.92） 0.85（95%CI：0.75～0.91） 0.88（95%CI：0.82～0.92） 诊断显著纤维化 0.86（95%CI：0.78～0.92） 0.81（95%CI：0.77～0.84） 0.88（95%CI：0.80～0.93） 0.77（95%CI：0.58～0.89） 
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