自身免疫性肝病肝纤维化无创诊断研究进展
DOI: 10.3969/j.issn.1001-5256.2023.11.026
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:马小涵负责文献检索和撰写论文;杨丽霞负责指导、修改论文并最终定稿。
Research advances in noninvasive diagnosis of liver fibrosis in autoimmune liver diseases
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摘要: 自身免疫性肝病(ALD)是一组由自身免疫反应介导的慢性炎症性肝病,可进展为肝纤维化、肝硬化甚至肝衰竭。ALD肝纤维化的早诊早治,动态随访,有助于改善疾病转归,甚至逆转早期肝硬化。由于肝活检存在局限性和潜在风险,寻找无创检测技术已成为肝纤维化领域的研究热点。本文综述了近年来与ALD肝纤维化相关的血清学标志物及影像学技术的研究进展,并分析了各种检测方法的优缺点及发展趋势。Abstract: Autoimmune liver diseases (ALD) are a group of chronic inflammatory liver diseases mediated by autoimmune response and can progress to liver fibrosis, liver cirrhosis, and even liver failure. Early diagnosis, early treatment, and dynamic follow-up of liver fibrosis in ALD may help to improve the prognosis of the disease and even reverse early-stage liver cirrhosis. Due to the limitations and potential risks of liver biopsy, the search for noninvasive techniques has become a research hotspot in the field of liver fibrosis. This article reviews the recent research advances in serum markers and imaging techniques for liver fibrosis in ALD and analyzes the advantages and disadvantages of each detection method and their development trends.
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Key words:
- Hepatitis, Autoimmune /
- Cholangitis, Sclerosing /
- Liver Cirrhosis /
- Diagnosis
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[1] FANG JM, CHENG J, CHANG MF, et al. Transient elastography versus liver biopsy: discordance in evaluations for fibrosis and steatosis from a pathology standpoint[J]. Mod Pathol, 2021, 34( 10): 1955- 1962. DOI: 10.1038/s41379-021-00851-5. [2] NEUBERGER J, PATEL J, CALDWELL H, et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology[J]. Gut, 2020, 69( 8): 1382- 1403. DOI: 10.1136/gutjnl-2020-321299. [3] GATSELIS NK, TORNAI T, SHUMS Z, et al. Golgi protein-73: A biomarker for assessing cirrhosis and prognosis of liver disease patients[J]. World J Gastroenterol, 2020, 26( 34): 5130- 5145. DOI: 10.3748/wjg.v26.i34.5130. [4] YAO M, WANG L, LEUNG P, et al. The clinical significance of GP73 in immunologically mediated chronic liver diseases: experimental data and literature review[J]. Clin Rev Allergy Immunol, 2018, 54( 2): 282- 294. DOI: 10.1007/s12016-017-8655-y. [5] YAO M, WANG L, WANG J, et al. Diagnostic value of serum golgi protein 73 for liver inflammation in patients with autoimmune hepatitis and primary biliary cholangitis[J]. Dis Markers, 2022, 2022: 4253566. DOI: 10.1155/2022/4253566. [6] WANG X, HE Y, MACKOWIAK B, et al. MicroRNAs as regulators, biomarkers and therapeutic targets in liver diseases[J]. Gut, 2021, 70( 4): 784- 795. DOI: 10.1136/gutjnl-2020-322526. [7] TADOKORO T, MORISHITA A, MASAKI T. Diagnosis and therapeutic management of liver fibrosis by microRNA[J]. Int J Mol Sci, 2021, 22( 15). DOI: 10.3390/ijms22158139. [8] MIGITA K, KOMORI A, KOZURU H, et al. Circulating microRNA profiles in patients with Type-1 autoimmune hepatitis[J]. PLoS One, 2015, 10( 11): e0136908. DOI: 10.1371/journal.pone.0136908. [9] TU H, CHEN D, CAI C, et al. microRNA-143-3p attenuated development of hepatic fibrosis in autoimmune hepatitis through regulation of TAK1 phosphorylation[J]. J Cell Mol Med, 2020, 24( 2): 1256- 1267. DOI: 10.1111/jcmm.14750. [10] FERNÁNDEZ-RAMOS D, FERNÁNDEZ-TUSSY P, LOPITZ-OTSOA F, et al. MiR-873-5p acts as an epigenetic regulator in early stages of liver fibrosis and cirrhosis[J]. Cell Death Dis, 2018, 9( 10): 958. DOI: 10.1038/s41419-018-1014-y. [11] PAN Y, WANG J, HE L, et al. MicroRNA-34a promotes EMT and liver fibrosis in primary biliary cholangitis by regulating TGF-β1/smad pathway[J]. J Immunol Res, 2021, 2021: 6890423. DOI: 10.1155/2021/6890423. [12] WAN Y, ZHOU T, SLEVIN E, et al. Liver-specific deletion of microRNA-34a alleviates ductular reaction and liver fibrosis during experimental cholestasis[J]. FASEB J, 2023, 37( 2): e22731. DOI: 10.1096/fj.202201453R. [13] BEKKI Y, YOSHIZUMI T, SHIMODA S, et al. Hepatic stellate cells secreting WFA+-M2BP: Its role in biological interactions with Kupffer cells[J]. J Gastroenterol Hepatol, 2017, 32( 7): 1387- 1393. DOI: 10.1111/jgh.13708. [14] FENG S, WANG Z, ZHAO Y, et al. Wisteria floribunda agglutinin-positive Mac-2-binding protein as a diagnostic biomarker in liver cirrhosis: an updated meta-analysis[J]. Sci Rep, 2020, 10( 1): 10582. DOI: 10.1038/s41598-020-67471-y. [15] NISHIKAWA H, ENOMOTO H, IWATA Y, et al. Clinical significance of serum Wisteria floribunda agglutinin positive Mac-2-binding protein level and high-sensitivity C-reactive protein concentration in autoimmune hepatitis[J]. Hepatol Res, 2016, 46( 7): 613- 621. DOI: 10.1111/hepr.12596. [16] UMEMURA T, JOSHITA S, SEKIGUCHI T, et al. Serum wisteria floribunda agglutinin-positive Mac-2-binding protein level predicts liver fibrosis and prognosis in primary biliary cirrhosis[J]. Am J Gastroenterol, 2015, 110( 6): 857- 864. DOI: 10.1038/ajg.2015.118. [17] UMETSU S, INUI A, SOGO T, et al. Usefulness of serum Wisteria floribunda agglutinin-positive Mac-2 binding protein in children with primary sclerosing cholangitis[J]. Hepatol Res, 2018, 48( 5): 355- 363. DOI: 10.1111/hepr.13004. [18] KARTASHEVA-EBERTZ D, GASTON J, LAIR-MEHIRI L, et al. IL-17A in human liver: Significant source of inflammation and trigger of liver fibrosis initiation[J]. Int J Mol Sci, 2022, 23( 17). DOI: 10.3390/ijms23179773. [19] LUO SY, LI TT, WANG YQ, et al. Diagnostic performance of peripheral blood Treg/Th17 cells and their related cytokines in predicting significant liver fibrosis in patients with primary biliary cholangitis[J]. J Prac Hepatol, 2022, 25( 5): 673- 676. DOI: 10.3969/j.issn.1672-5069.2022.05.017.骆苏彦, 李婷婷, 王亚奇, 等. 原发性胆汁性胆管炎患者外周血Treg/Th17细胞相关细胞因子水平变化[J]. 实用肝脏病杂志, 2022, 25( 5): 673- 676. DOI: 10.3969/j.issn.1672-5069.2022.05.017. [20] JIA H, CHEN J, ZHANG X, et al. IL-17A produced by invariant natural killer T cells and CD3+CD56+αGalcer-CD1d tetramer-T cells promote liver fibrosis in patients with primary biliary cholangitis[J]. J Leukoc Biol, 2022, 112( 5): 1079- 1087. DOI: 10.1002/JLB.2A0622-586RRRR. [21] BAUER A, HABIOR A. Concentration of serum matrix metalloproteinase-3 in patients with primary biliary cholangitis[J]. Front Immunol, 2022, 13: 885229. DOI: 10.3389/fimmu.2022.885229. [22] HUANG B, LYU Z, QIAN Q, et al. NUDT1 promotes the accumulation and longevity of CD103+ TRM cells in primary biliary cholangitis[J]. J Hepatol, 2022, 77( 5): 1311- 1324. DOI: 10.1016/j.jhep.2022.06.014. [23] POVERO D, TAMEDA M, EGUCHI A, et al. Protein and miRNA profile of circulating extracellular vesicles in patients with primary sclerosing cholangitis[J]. Sci Rep, 2022, 12( 1): 3027. DOI: 10.1038/s41598-022-06809-0. [24] LIU R, LI X, ZHU W, et al. Cholangiocyte-derived exosomal long noncoding RNA H19 promotes hepatic stellate cell activation and cholestatic liver fibrosis[J]. Hepatology, 2019, 70( 4): 1317- 1335. DOI: 10.1002/hep.30662. [25] ZHANG J, LYU Z, LI B, et al. P4HA2 induces hepatic ductular reaction and biliary fibrosis in chronic cholestatic liver diseases[J]. Hepatology, 2023, 78( 1): 10- 25. DOI: 10.1097/HEP.0000000000000317. [26] DONG B, CHEN Y, LYU G, et al. Aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in patients with autoimmune hepatitis: A meta-analysis[J]. Front Immunol, 2022, 13: 892454. DOI: 10.3389/fimmu.2022.892454. [27] JIANG M, YAN X, SONG X, et al. Total bile acid to platelet ratio: A noninvasive index for predicting liver fibrosis in primary biliary cholangitis[J]. Medicine(Baltimore), 2020, 99( 22): e20502. DOI: 10.1097/MD.0000000000020502. [28] AVCIOĞLU U, ERUZUN H, USTAOĞLU M. The gamma-glutamyl transferase to platelet ratio for noninvasive evaluation of liver fibrosis in patients with primary biliary cholangitis[J]. Medicine(Baltimore), 2022, 101( 40): e30626. DOI: 10.1097/MD.0000000000030626. [29] SAYAR S, GOKCEN P, AYKUT H, et al. Can simple non-invasive fibrosis models determine prognostic indicators(fibrosis and treatment response) of primary biliary cholangitis?[J]. Sisli Etfal Hastan Tip Bul, 2021, 55( 3): 412- 418. DOI: 10.14744/SEMB.2021.95825. [30] HU M, YOU Z, LI Y, et al. Serum biomarkers for autoimmune hepatitis type 1: the case for CD48 and a review of the literature[J]. Clin Rev Allergy Immunol, 2022, 63( 3): 342- 356. DOI: 10.1007/s12016-022-08935-z. [31] YANG ZR, WANG LH, LI Y, et al. Diagnostic value of transient elastography in the staging of hepatic fibrosis in patients with autoimmune liver disease: A Meta-analysis[J]. J Clin Hepatol, 2022, 38( 1): 97- 103. DOI: 10.3969/j.issn.1001-5256.2022.01.015.杨志然, 王林恒, 李园, 等. 瞬时弹性成像技术对自身免疫性肝病肝纤维化分期诊断价值的Meta分析[J]. 临床肝胆病杂志, 2022, 38( 1): 97- 103. DOI: 10.3969/j.issn.1001-5256.2022.01.015. [32] XU Q, SHENG L, BAO H, et al. Evaluation of transient elastography in assessing liver fibrosis in patients with autoimmune hepatitis[J]. J Gastroenterol Hepatol, 2017, 32( 3): 639- 644. DOI: 10.1111/jgh.13508. [33] HARTL J, DENZER U, EHLKEN H, et al. Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis[J]. J Hepatol, 2016, 65( 4): 769- 775. DOI: 10.1016/j.jhep.2016.05.023. [34] HARTL J, EHLKEN H, SEBODE M, et al. Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis[J]. J Hepatol, 2018, 68( 4): 754- 763. DOI: 10.1016/j.jhep.2017.11.020. [35] CORPECHOT C, CARRAT F, POUJOL-ROBERT A, et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis[J]. Hepatology, 2012, 56( 1): 198- 208. DOI: 10.1002/hep.25599. [36] CRISTOFERI L, CALVARUSO V, OVERI D, et al. Accuracy of transient elastography in assessing fibrosis at diagnosis in naïve patients with primary biliary cholangitis: A dual cut-off approach[J]. Hepatology, 2021, 74( 3): 1496- 1508. DOI: 10.1002/hep.31810. [37] CORPECHOT C, CARRAT F, GAOUAR F, et al. Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis[J]. J Hepatol, 2022, 77( 6): 1545- 1553. DOI: 10.1016/j.jhep.2022.06.017. [38] CORPECHOT C, GAOUAR F, NAGGAR A EL, et al. Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis[J]. Gastroenterology, 2014, 146( 4): 970- 979; quiz e15- 16. DOI: 10.1053/j.gastro.2013.12.030. [39] WU HM, SHENG L, WANG Q, et al. Performance of transient elastography in assessing liver fibrosis in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome[J]. World J Gastroenterol, 2018, 24( 6): 737- 743. DOI: 10.3748/wjg.v24.i6.737. [40] ZENG J, HUANG ZP, ZHENG J, et al. Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases[J]. World J Gastroenterol, 2017, 23( 26): 4839- 4846. DOI: 10.3748/wjg.v23.i26.4839. [41] XING X, YAN Y, SHEN Y, et al. Liver fibrosis with two-dimensional shear-wave elastography in patients with autoimmune hepatitis[J]. Expert Rev Gastroenterol Hepatol, 2020, 14( 7): 631- 638. DOI: 10.1080/17474124.2020.1779589. [42] YAN Y, XING X, LU Q, et al. Assessment of biopsy proven liver fibrosis by two-dimensional shear wave elastography in patients with primary biliary cholangitis[J]. Dig Liver Dis, 2020, 52( 5): 555- 560. DOI: 10.1016/j.dld.2020.02.002. [43] YAN YL, XING X, WANG Y, et al. Clinical utility of two-dimensional shear-wave elastography in monitoring disease course in autoimmune hepatitis-primary biliary cholangitis overlap syndrome[J]. World J Gastroenterol, 2022, 28( 18): 2021- 2033. DOI: 10.3748/wjg.v28.i18.2021. [44] SOH EG, LEE YH, KIM YR, et al. Usefulness of 2D shear wave elastography for the evaluation of hepatic fibrosis and treatment response in patients with autoimmune hepatitis[J]. Ultrasonography, 2022, 41( 4): 740- 749. DOI: 10.14366/usg.21266. [45] GALINA P, ALEXOPOULOU E, MENTESSIDOU A, et al. Diagnostic accuracy of two-dimensional shear wave elastography in detecting hepatic fibrosis in children with autoimmune hepatitis, biliary atresia and other chronic liver diseases[J]. Pediatr Radiol, 2021, 51( 8): 1358- 1368. DOI: 10.1007/s00247-020-04959-9. [46] WANG J, MALIK N, YIN M, et al. Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis[J]. World J Gastroenterol, 2017, 23( 5): 859- 868. DOI: 10.3748/wjg.v23.i5.859. [47] OSMAN KT, MASELLI DB, IDILMAN IS, et al. Liver Stiffness Measured by Either Magnetic Resonance or Transient Elastography Is Associated With Liver Fibrosis and Is an Independent Predictor of Outcomes Among Patients With Primary Biliary Cholangitis[J]. J Clin Gastroenterol, 2021, 55( 5): 449- 457. DOI: 10.1097/MCG.0000000000001433. [48] EATON JE, DZYUBAK B, VENKATESH SK, et al. Performance of magnetic resonance elastography in primary sclerosing cholangitis[J]. J Gastroenterol Hepatol, 2016, 31( 6): 1184- 1190. DOI: 10.1111/jgh.13263. [49] TAFUR M, CHEUNG A, MENEZES RJ, et al. Risk stratification in primary sclerosing cholangitis: comparison of biliary stricture severity on MRCP versus liver stiffness by MR elastography and vibration-controlled transient elastography[J]. Eur Radiol, 2020, 30( 7): 3735- 3747. DOI: 10.1007/s00330-020-06728-6. [50] ISMAIL MF, HIRSCHFIELD GM, HANSEN B, et al. Evaluation of quantitative MRCP(MRCP+) for risk stratification of primary sclerosing cholangitis: comparison with morphological MRCP, MR elastography, and biochemical risk scores[J]. Eur Radiol, 2022, 32( 1): 67- 77. DOI: 10.1007/s00330-021-08142-y. [51] JHAVERI KS, HOSSEINI-NIK H, SADOUGHI N, et al. The development and validation of magnetic resonance elastography for fibrosis staging in primary sclerosing cholangitis[J]. Eur Radiol, 2019, 29( 2): 1039- 1047. DOI: 10.1007/s00330-018-5619-4. [52] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary sclerosing cholangitis(2021)[J]. J Clin Hepatol, 2022, 38( 1): 50- 61. DOI: 10.3969/j.issn.1001-5256.2022.01.009.中华医学会肝病学分会. 原发性硬化性胆管炎诊断及治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38( 1): 50- 61. DOI: 10.3969/j.issn.1001-5256.2022.01.009. -
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