血清生化标志综合模型评估肝纤维化的现状

肝活检是诊断肝纤维化的金标准,但其为创伤性的,且有局限性。肝纤维化和肝硬化的非创伤性诊断方法有:血清学诊断、影像学诊断和肝脏弹性检测等。肝纤维化的血清学诊断指标包括:反映细胞外基质分泌的指标、细胞因子、蛋白聚糖及反映肝生化功能的标志。肝纤维化非创伤性生化标志综合模型是目前的研究热点。本文对血清生化标志综合模型评估肝纤维化的现状作一综述。     

肝纤维化血清学诊断研究进展

肝纤维化是由各种慢性肝病引起细胞外基质在肝脏过度沉积所致,可进展为肝硬化并导致肝功能衰竭和门静脉高压等。肝纤维化具有可逆性已成为共识。因此,准确诊断和评估肝纤维化程度对肝纤维化的防治及其预后评估具有非常重要的意义。肝纤维化诊断的金标准是肝脏活检,但由于其具有创伤性、费用昂贵而难以被患者接受。血清学检查是诊断肝纤维化较为理想的检测方法,可对肝纤维化进行早期诊断,并可进行动态观察。由多个血清学指标组成的非创伤性诊断模型,提高了肝纤维化的诊断准确性。本文就肝纤维化的血清学诊断研究进展进行综述。     

丙型肝炎诊断试验及其应用分析

临床上采用丙型肝炎(丙肝)病毒(HCV)标志物来诊断丙型肝炎和评价抗病毒药物疗效,如抗HCV、HCV RNA定性和定量试验以及HCV基因型;衡量丙肝肝纤维化和肝硬化常采用肝功能试验、非创伤性肝纤维化血清学标志、影像学、肝活体组织检     

肝纤维化无创性诊断技术的临床应用

肝纤维化是各种病因引起的慢性肝病的共同转归。目前,肝活组织检查是肝纤维化诊断的"金标准",但其有一定的创伤性及局限性,因此无创评估肝纤维化技术得到了推行和发展。主要从临床表现、血清学及影像学等方面介绍了无创性诊断肝纤维化技术及其应用,指出了这些无创性诊断技术的临床价值,并针对目前无创诊断肝纤维化在临床研究的进展及其局限性进行了探讨。     

肝纤维化的诊断和评估

肝纤维化是一种病理状态，又是一组临床和病理学综合征，其诊断有赖于临床评估、血清生化指标检测、影像学检查和组织病理学检查等。除了组织病理学诊断外，目前尚无准确和敏感的肝纤维化非创伤性的诊断方法，准确诊断和评估肝纤维化程度对肝纤维化的防治及其预后评估有非常重要的意义。     

丙型肝炎诊断试验及其应用的解析

临床上采用丙型肝炎病毒 (HCV)标志来诊断丙型肝炎和评价抗病毒药物疗效 ,如抗HCV、HCVRNA定性和定量试验和HCV基因型 ;衡量丙型肝炎纤维化和肝硬化常采用肝功能试验、非创伤性肝纤维化血清学标志、影像学、肝活组织检查 ;丙型肝炎导致肝细胞癌 (HCC)可采用甲胎蛋白 (AFP)和影像学检查。现参照美国国家卫生研究院 (NIH)丙型肝炎共识 ( 2 0 0 2年 ) ,欧洲肝病年会 ( 2 0 0 2年 ) ,疾病预防控制中心 (CDC)抗HCV检测与报告指南 ( 2 0 0 3年 )和我国情况作一介绍和分析。一、HCV的血清学和病毒学诊断HCV感染的诊断中 ,血清丙氨酸…     

非创伤性诊断肝纤维化临床研究进展

正确评估肝纤维化程度有利于临床治疗和随访慢性肝病。笔者就非创伤性诊断肝纤维化的不同方法、适应证和步骤的最新进展进行讨论。瞬间弹性超声检查与多项血清标志物组合的诊断模型,符合非创伤性肝纤维化诊断技术的多项要求,能有效诊断严重肝纤维化（S≥3期）,但区分轻、中度肝纤维化（S≤2期）欠佳。目前,非创伤性诊断肝纤维化方法仍不成熟,还不能完全取代肝脏活体组织检查。     

重视肝纤维化的诊断和评估

肝纤维化是各种慢性肝病向肝硬化发展过程中的关键步骤和影响慢性肝病患者预后的重要环节。尽管目前对肝纤维化尚无确切的有效干预手段,但无论是临床医师还是患者仍急切需求对其进行早期诊断和评估。因此,需要加强肝纤维化早期诊断和评估的研究,为临床诊治和预后判断提供更好的依据[1]。尽管这些年很多学者对肝纤维化的诊断和评估做了大量的研究工作,尤其是在非创伤性诊断和评估方面,包括一些无创血清诊断模型和影像学检查等非创伤性检测方法,对肝纤维化有较高的诊断价值,但由于各存缺陷和准确性差强人意,目前肝活检仍然是诊断肝纤维化的“金标准”。     

肝纤维化无创性诊断技术应用的新进展

肝纤维化准确分期对指导临床治疗具有重要意义,无创性诊断技术可使患者避免或减少肝活组织检查,有可能成为临床诊断肝纤维化的重要手段。笔者通过对患者的临床、血清学及影像学等肝纤维化资料的评估,介绍了提高肝纤维化及肝硬化诊断率的无创性诊断技术新进展。     

肝纤维化血清学诊断进展

早期发现肝纤维化并使之降解逆转是当前肝脏病学的研究热点,但是肝纤维化的早期诊断存在一些困难。常规肝功能试验无法判断早期或轻度肝纤维化,肝组织活检又由于其检查过程的创伤性、穿刺部位的局限性及动态观察的困难性,难以广泛开展。因此探索肝纤维化的血清学诊断有很重要的科研价     

肝纤维化血清学无创检测研究进展

肝纤维化指肝脏细胞外基质弥漫性的过度沉积,是机体对于肝实质损伤的一种修复反应及许多慢性肝病共同的病理过程,也是各种慢性肝病向肝硬化发展的重要步骤.迄今为止,临床尚缺乏特异性有效逆转或阻止肝纤维化进展的药物,尽早对肝纤维化进行诊断具有重要意义.目前肝纤维化的诊断主要靠组织病理学、血清学标志物及影像学手段.肝活检被认为是肝...     

肝纤维化的诊断进展

肝纤维化是肝硬化的病理学基础,早期诊断肝纤维化对防止肝硬化具有十分重要的意义。本文就血清学指标、影像学指标、组织学活检及参数模型诊断肝纤维化研究进展进行综述。     

肝纤维化血清学诊断指标研究进展

肝纤维化是肝脏组织损伤后的不完全修复过程,是慢性肝病最重要的病理特征,也是肝硬化发展的必经途径和进一步恶化的重要原因。肝纤维化的诊断方法包括影像学、病理学和血清学3种。影像学诊断在肝纤维化晚期才能出现异常图像;病理学诊断是金标准,但存在肝穿刺的盲目性、肝脏病变的不均一性而导致取样误差;血清学诊断是应用最广泛的诊断方法。本文对肝纤维化的血清学诊断指标在肝纤维化诊断上的优缺点进行综述。     

Magnetic resonance imaging of hepatic fibrosis: emerging clinical applications

Chronic liver disease and cirrhosis remains a major public health problem worldwide. While the majority of complications from chronic liver disease result from progressive hepatic fibrosis, the available diagnostic tests used in clinical practice are not sensitive or specific enough to detect occult liver injury at early or intermediate stages. While liver biopsy can stage the extent of fibrosis at diagnosis, its utility as a tool for longitudinal monitoring will be limited at the population level. To date, a number of methods including serum marker panels and ultrasound-based transient elastrography have been proposed for the non-invasive identification of hepatic fibrosis. Novel techniques including magnetic resonance (MR) spectroscopy, diffusion weighted MR, and MR elastography have also emerged for detecting fibrosis. In contrast to other non-invasive methods, MR imaging holds the promise of providing functional and biological information about hepatic pathophysiology as it relates to the natural history and future treatment of hepatic fibrosis. (HEPATOLOGY 2007.).     

Radiologic evaluation of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a frequent cause of chronic liver diseases, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH)-related liver cirrhosis. Although liver biopsy is still the gold standard for the diagnosis of NAFLD, especially for the diagnosis of NASH, imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy. Ultrasonography is a well-established and cost-effective imaging technique for the diagnosis of hepatic steatosis, especially for screening a large population at risk of NAFLD. Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis, operator-dependent, and rather qualitative. Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard. However, computed tomography may be effective in specific clinical situations, such as evaluation of donor candidates for hepatic transplantation. Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice, especially for longitudinal follow-up of patients with NAFLD. Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis. This article will review current imaging methods used to evaluate hepatic steatosis, including the diagnostic accuracy, limitations, and practical applicability of each method. It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.     

Non-invasive evaluation of liver steatosis with imaging modalities: New techniques and applications

In the world, nonalcoholic fatty liver disease(NAFLD) accounts for majority of diffuse hepatic diseases. Notably, substantial liver fat accumulation can trigger and accelerate hepatic fibrosis, thus contributing to disease progression. Moreover, the presence of NAFLD not only puts adverse influences for liver but is also associated with an increased risk of type 2 diabetes and cardiovascular diseases. Therefore, early detection and quantified measurement of hepatic fat content are of great impor...     

Duration of hepatic iron exposure increases the risk of significant fibrosis in hereditary hemochromatosis: a new role for magnetic resonance imaging

OBJECTIVES: Hepatic fibrosis is a complication of hereditary hemochromatosis. The aim of this study was to determine whether the product of the magnitude and duration of hepatic iron exposure is related to the risk of significant fibrosis. METHODS: Receiver-operating characteristic curve analysis to determine the utility of hepatic iron concentration (HIC) and age in the diagnosis of low- or high-grade fibrosis was undertaken retrospectively in 60 subjects who had undergone liver biopsy for assessment of hereditary hemochromatosis. A prospective pilot study was then conducted in 10 additional subjects to evaluate utility of magnetic resonance imaging (MRI) measurements of HIC to predict fibrosis. RESULTS: Eighteen subjects had high-grade fibrosis while 42 subjects had low-grade fibrosis. Hepatic iron concentration alone was highly sensitive (100%) but of limited specificity (67%) in diagnosis of high-grade fibrosis. The product of [HIC x age] had a sensitivity and specificity of 100% and 86%, respectively, for diagnosis of high-grade fibrosis. Magnetic resonance imaging measurements also provided accurate assignment of subjects into fibrosis severity groups. CONCLUSIONS: Duration of exposure to iron is important in the development of hepatic fibrosis in hereditary hemochromatosis. The product of HIC and age is highly sensitive and specific for diagnosis of high-grade fibrosis and can be obtained using MRI.     

Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in the United States.While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation,no imaging modality is recommended as standard of care for screening or diagnosis.Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings.Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes,increased hepatorenal echogenicity,vascular blurring of portal or hepatic vein and subcutaneous tissue thickness.These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD.While sonographic findings such as attenuation of image,diffuse echogenicity,uniform heterogeneous liver,thick subcutaneous depth,and enlarged liver filling of the entire field could be identifiedby clinicians from bedside ultrasound.The accessibility,ease of use,and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis.When used with appropriate clinical risk factors and steatosis involves greater than 33%of the liver,ultrasound can reliably diagnose NAFLD.Despite the ability of ultrasound in detecting moderate hepatic steatosis,it cannot replace liver biopsy in staging the degree of fibrosis.The purpose of this review is to examine the diagnostic accuracy,utility,and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.     

肝纤维化患者肝脏形态学改变的CT、MR评价

目的 评价肝纤维化患者肝脏形态学改变ＣＴ、ＭＲ表现。方法 对１６８例经肝穿刺活检病理证实的肝纤维化患者行ＣＴ和／或ＭＲ检查。根据肝纤维化炎症活动度分级和纤维化程度分期进行肝脏形态学改变和相关指标的统计分析。结果 肝左叶体积、肝表面形态和肝裂增宽等肝脏形态学改变随着肝纤维化严重程度的加重而有统计学差异。结论 无创伤性的ＣＴ、ＭＲ检查是临床评价肝脏形态学改变和动态观察肝纤维化病程演进的有效手段。