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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 42 Issue 7
Jul.  2026
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Article Contents

Clinical evaluation of liver fibrosis regression: A multimodal precision strategy based on histology, serology, and imaging

DOI: 10.12449/JCH260727
Research funding:

Special Project of Pathogenology and Epidemic Prevention Technology System Research under the National Key R&D Program during the 14th Five-Year Plan Period (2023YFC2306900)

More Information
  • Corresponding author: Wu Xiaoning, wuxiaoningbs@126.com (ORCID: 0000-0001-5416-712X)
  • Received Date: 2025-11-17
  • Accepted Date: 2026-02-11
  • Published Date: 2026-07-25
  • Liver fibrosis is a key pathological stage in the progression of chronic liver diseases to liver cirrhosis, and effective etiological control or therapeutic interventions can help to achieve varying degrees of liver fibrosis regression in some patients. Accordingly, accurate assessment of the degree of liver fibrosis regression has gradually become an important concern in clinical management and the development of novel therapeutic agents. Conventional assessment methods mainly focus on fibrosis staging and have certain limitations in reflecting structural remodeling and dynamic changes of the liver. This article systematically reviews the recent research advances in the assessment of liver fibrosis regression from various aspects such as histological and digital pathology, serological and multi-omics biomarkers, and functional and molecular imaging modalities and discusses their respective advantages and limitations in assessing liver fibrosis regression. On this basis, this article discusses a multimodal integrated evaluation strategy based on artificial intelligence, in order to provide new ideas for accurate assessment of liver fibrosis regression, individualized therapeutic monitoring, and optimization of clinical trial endpoints.

     

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  • [1]
    Kisseleva T, Brenner D. Molecular and cellular mechanisms of liver fibrosis and its regression[J]. Nat Rev Gastroenterol Hepatol, 2021, 18( 3): 151- 166. DOI: 10.1038/s41575-020-00372-7.
    [2]
    Wu Wenyue, Sun Yameng, You Hong. Liver fibrosis reversal: Small progress awaits a major breakthrough[J]. Chin Hepatol, 2024, 29( 1): 13- 15. DOI: 10.3969/j.issn.1008-1704.2024.01.005.

    吴雯玥, 孙亚朦, 尤红. 肝纤维化逆转: 小进步尚待大突破[J]. 肝脏, 2024, 29( 1): 13- 15. DOI: 10.3969/j.issn.1008-1704.2024.01.005.
    [3]
    Marcellin P, Gane E, Buti M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: A 5-year open-label follow-up study[J]. Lancet, 2013, 381( 9865): 468- 475. DOI: 10.1016/S0140-6736(12)61425-1.
    [4]
    Chang T T, Liaw Y F, Wu S S, et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B[J]. Hepatology, 2010, 52( 3): 886- 893. DOI: 10.1002/hep.23785.
    [5]
    Lin J Y, Huang Y, Xu B Y, et al. Effect of dapagliflozin on metabolic dysfunction-associated steatohepatitis: Multicentre, double blind, randomised, placebo controlled trial[J]. BMJ, 2025, 389: e083735. DOI: 10.1136/bmj-2024-083735.
    [6]
    Harrison S A, Bedossa P, Guy C D, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis[J]. N Engl J Med, 2024, 390( 6): 497- 509. DOI: 10.1056/NEJMoa2309000.
    [7]
    Sanyal A J, Newsome P N, Kliers I, et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis[J]. N Engl J Med, 2025, 392( 21): 2089- 2099. DOI: 10.1056/NEJMoa2413258.
    [8]
    Lassailly G, Caiazzo R, Ntandja-Wandji L C, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis[J]. Gastroenterology, 2020, 159( 4): 1290- 1301. e 5. DOI: 10.1053/j.gastro.2020.06.006.
    [9]
    Zhu Tingting, Chen Yiyun, Xie Fanci, et al. Non-invasive assessment of liver fibrosis reverse in patients with chronic liver diseases[J]. J Pract Hepatol, 2025, 28( 2): 169- 172. DOI: 10.3969/j.issn.1672-5069.2025.02.003.

    朱亭亭, 陈逸云, 谢帆慈, 等. 无创评估肝纤维化逆转研究进展[J]. 实用肝脏病杂志, 2025, 28( 2): 169- 172. DOI: 10.3969/j.issn.1672-5069.2025.02.003.
    [10]
    Sun Y M, Zhou J L, Wang L, et al. New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment[J]. Hepatology, 2017, 65( 5): 1438- 1450. DOI: 10.1002/hep.29009.
    [11]
    Chang X J, Lv C H, Wang B Q, et al. The utility of P-I-R classification in predicting the on-treatment histological and clinical outcomes of patients with hepatitis B and advanced liver fibrosis[J]. Hepatology, 2024, 79( 2): 425- 437. DOI: 10.1097/HEP.0000000000000563.
    [12]
    Sun Y M, Chen W, Chen S Y, et al. Regression of liver fibrosis in patients on hepatitis B therapy is associated with decreased liver-related events[J]. Clin Gastroenterol Hepatol, 2024, 22( 3): 591- 601. e 3. DOI: 10.1016/j.cgh.2023.11.017.
    [13]
    Tong X F, Sun Y M, Wang Q Y, et al. Delicate and thin fibrous Septa indicate a regression tendency in metabolic dysfunction-associated steatohepatitis patients with advanced fibrosis[J]. Hepatol Int, 2025, 19( 1): 166- 180. DOI: 10.1007/s12072-024-10719-w.
    [14]
    Wang B Q, Sun Y M, Zhou J L, et al. SHG/TPEF-based image technology improves liver fibrosis assessment of minimally sized needle biopsies[J]. Hepatol Int, 2019, 13( 4): 501- 509. DOI: 10.1007/s12072-019-09955-2.
    [15]
    Naoumov N V, Kleiner D E, Chng E, et al. Digital quantitation of bridging fibrosis and Septa reveals changes in natural history and treatment not seen with conventional histology[J]. Liver Int, 2024, 44( 12): 3214- 3228. DOI: 10.1111/liv.16092.
    [16]
    Abdurrachim D, Lek S, Ong C Z L, et al. Utility of AI digital pathology as an aid for pathologists scoring fibrosis in MASH[J]. J Hepatol, 2025, 82( 5): 898- 908. DOI: 10.1016/j.jhep.2024.11.032.
    [17]
    Liu Tianhui. Serological assessment of the reversal of liver fibrosis and cirrhosis[J]. J Clin Hepatol, 2019, 35( 4): 714- 719. DOI: 10.3969/j.issn.1001-5256.2019.04.003.

    刘天会. 肝纤维化和肝硬化逆转的血清学评价[J]. 临床肝胆病杂志, 2019, 35( 4): 714- 719. DOI: 10.3969/j.issn.1001-5256.2019.04.003.
    [18]
    Liu T H, Sun Y M, Zhou J L, et al. On-treatment changes of serum Wisteria floribunda agglutinin-positive Mac-2 binding protein are associated with the regression of liver fibrosis in chronic hepatitis B patients on interferon α add-on therapy[J]. J Med Virol, 2019, 91( 8): 1499- 1509. DOI: 10.1002/jmv.25465.
    [19]
    Wang L, Liu T H, Zhou J L, et al. Changes in serum chitinase 3-like 1 levels correlate with changes in liver fibrosis measured by two established quantitative methods in chronic hepatitis B patients following antiviral therapy[J]. Hepatol Res, 2018, 48( 3): E283- E290. DOI: 10.1111/hepr.12982.
    [20]
    Kim W R, Berg T, Asselah T, et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients[J]. J Hepatol, 2016, 64( 4): 773- 780. DOI: 10.1016/j.jhep.2015.11.012.
    [21]
    Ghoneim S, Butt M U, Trujillo S, et al. FIB-4 regression with direct-acting antiviral therapy in patients with hepatitis C infection: A safety-net hospital experience[J]. Front Med, 2020, 7: 359. DOI: 10.3389/fmed.2020.00359.
    [22]
    Gounder P P, Haering C, Bruden D J T, et al. Does incorporating change in APRI or FIB-4 indices over time improve the accuracy of a single index for identifying liver fibrosis in persons with chronic hepatitis C virus infection?[J]. J Clin Gastroenterol, 2018, 52( 1): 60- 66. DOI: 10.1097/MCG.0000000000000753.
    [23]
    Kjaergaard M, Lindvig K P, Thorhauge K H, et al. Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease[J]. J Hepatol, 2023, 79( 2): 277- 286. DOI: 10.1016/j.jhep.2023.04.002.
    [24]
    D’Ambrosio R, Degasperi E, Aghemo A, et al. Serological tests do not predict residual fibrosis in hepatitis C cirrhotics with a sustained virological response to interferon[J]. PLoS One, 2016, 11( 6): e0155967. DOI: 10.1371/journal.pone.0155967.
    [25]
    Dong X Q, Wu Z, Zhao H, et al. Evaluation and comparison of thirty noninvasive models for diagnosing liver fibrosis in Chinese hepatitis B patients[J]. J Viral Hepat, 2019, 26( 2): 297- 307. DOI: 10.1111/jvh.13031.
    [26]
    Codotto G, Blarasin B, Tiribelli C, et al. Decoding liver fibrosis: How omics technologies and innovative modeling can guide precision medicine[J]. Int J Mol Sci, 2025, 26( 6): 2658. DOI: 10.3390/ijms26062658.
    [27]
    Mendoza Y P, Tsouka S, Semmler G, et al. Metabolic phenotyping of patients with advanced chronic liver disease for better characterization of cirrhosis regression[J]. J Hepatol, 2024, 81( 6): 983- 994. DOI: 10.1016/j.jhep.2024.06.028.
    [28]
    Forlano R, Martinez-Gili L, Takis P, et al. Disruption of gut barrier integrity and host-microbiome interactions underlie MASLD severity in patients with type-2 diabetes mellitus[J]. Gut Microbes, 2024, 16( 1): 2304157. DOI: 10.1080/19490976.2024.2304157.
    [29]
    Ji D, Chen Y, Shang Q H, et al. Unreliable estimation of fibrosis regression during treatment by liver stiffness measurement in patients with chronic hepatitis B[J]. Am J Gastroenterol, 2021, 116( 8): 1676- 1685. DOI: 10.14309/ajg.0000000000001239.
    [30]
    Kong Y Y, Sun Y M, Zhou J L, et al. Early steep decline of liver stiffness predicts histological reversal of fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Viral Hepat, 2019, 26( 5): 576- 585. DOI: 10.1111/jvh.13058.
    [31]
    Imajo K, Honda Y, Kobayashi T, et al. Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2022, 20( 4): 908- 917. e 11. DOI: 10.1016/j.cgh.2020.12.016.
    [32]
    Venkatesh S K, Yin M, Ehman R L. Magnetic resonance elastography of liver: Clinical applications[J]. J Comput Assist Tomogr, 2013, 37( 6): 887- 896. DOI: 10.1097/RCT.0000000000000032.
    [33]
    QIBA MRE Biomarker Committee. MR elastography of the liver, clinically feasible profile: Maintenance draft[R]. Quantitative Imaging Biomarkers Alliance, 2023. DOI: 10.1148/QIBA/20231107.
    [34]
    Song Y, Qin C X, Chen Y X, et al. Non-invasive visualization of liver fibrosis with[68Ga] Ga-DOTA-FAPI-04 PET from preclinical insights to clinical translation[J]. Eur J Nucl Med Mol Imaging, 2024, 51( 12): 3572- 3584. DOI: 10.1007/s00259-024-06773-z.
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