瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展

doi:10.3969/j.issn.1672-5069.2016.05.031

摘要/Abstract

摘要： 肝脏纤维化程度及进展与慢性肝脏疾病的诊断与治疗密切相关。早期诊断肝纤维化程度有助于避免代偿期患者向肝硬化失代偿期发展,也有助于降低肝细胞癌的发生率。目前,临床上评估肝纤维化程度的“金标准”仍为肝脏穿刺活检,但是由于其操作的有创性,以及穿刺后可能出现的多种并发症等多种因素的影响,限制了它在临床研究中的使用。瞬时弹性成像技术无创、安全、有利于动态监测肝纤维化进展、客观评价肝脏纤维化程度,使其在国内外得到了广泛的认同,在临床上具有良好的应用前景。

关键词: 肝纤维化, 瞬时弹性成像技术, 无创诊断

Abstract: The liver fibrosis is closely related to the diagnosis and treatment of chronic liver diseases. Early diagnosis of liver fibrosis might help patients with compensated liver functions slow down to the decompensated period,and also reduce the incidence of hepatocellular carcinoma. Liver biopsy is considered as the gold standard to assess the extent of liver damage in patients with chronic liver disease,but it is invasive. Transient elastography is a relatively novel,safe,noninvasive technique to evaluate liver stiffness. It can not only monitor the progression of liver fibrosis dynamically,but also objectively evaluate the liver damage. It is now widely used in clinic. In this review,the value of transient elastography in diagnosis of liver fibrosis was discussed.

Key words: Liver fibrosis, Transient elastography, Noninvasive assessment

沈斐斐综述, 陆伦根审校. 瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展[J]. 实用肝脏病杂志, 2016, 19(5): 620-623.

Shen Feifei, Lu Lungen.. Noninvasive assessment of liver fibrosis by transient elastography in patients with chronic liver disease[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(5): 620-623.

参考文献

[1] Bataller R,Brenner DA. Liver fibrosis. J Clin Invest,2005,115（2）:209-218.
[2] Safadi R,Friedman SL. Hepatic fibrosis-role of hepatic stellate cell activation. Med Gen Med,2002,4（3）:27.
[3] Tsochatzis EA,Bosch J,Burroughs AK. New therapeutic paradigm for patients with cirrhosis. Hepatology,2012,56（5）:1983-1992.
[4] Saadch S,Cammel C,Carey WD,et al. The role of liver biopsy in chronic hepatitis C. Hepatology,2001,33（1）:196-200.
[5] Poynard T,Raiziu V,Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol,2000,14（6）:543-548.
[6] Bedossa P,Daegere D,Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology,2003,38（6）:1449-1457.
[7] Regev A,Berho M,Jeffers LJ,et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic hcv infection. Am J Gastroenterol,2002,97（10）:2614-2618.
[8] Siddique I,EI-Naga HA,Madda JP,et al. Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis c virus infection. Scand J Gasteroenterol,2003,38（4）:427-432.
[9] Jung MK,Cho HJ,Lee HC,et a1. Comparison of transient elastography and hepatic fibrosis assessed by histology in chronic liver disease. Korean J Gastroenterol,2008,51（4）:241-247.
[10] Ophir J,Cespedes I,Ponnekanti H,et a1. Elastography：a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging,1991,13（2）:111-134.
[11] Taylor LS,Porter BC,Rubens DJ,et a1. Three-dimensional sonoelastography:principles and practices. Phys Med Biol,2000,45（6）:1477-1494.
[12] Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology,2012,142（6）:1293-1302.e4.
[13] Castera L,Pinzani M,Bosch J. Non invasive evaluation of portal hypertension using transient elastography. J Hepatol,2012,56（3）:696-703.
[14] Chon YE,Choi EH,Song KJ,et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B:a meta-analysis. PLoS One,2012,7（9）:e44930.
[15] Papatheodoridis GV,Manolakopoulos S,Margariti A,et al. The usefulness of transient elastography in the assessment of patients with HBeAg-negative chronic hepatitis b virus infection. J Viral Hepat,2014,21（7）:517-524.
[16] Friedrich-Rust M,Lupsor M,de Knegt R,et al. Point shear wave elastography by acoustic radiation force impulse quantification in comparison to transient elastography for the noninvasive assessment of liver fibrosis in chronic hepatitis C:a prospective international multicenter study. Ultraschall Med,2015,36（3）:239-247.
[17] Friedrich-Rust M,Ong MF,Martens S,et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology,2008,134（4）:960-974.
[18] Tsochatzis EA,Gurusamy KS,Ntaoula S,et al. Elastography for the diagnosis of severity of fibrosis in chronic liver disease:a meta-analysis of diagnostic accuracy. J Hepatol,2011,54（4）:650-659.
[19] Corpechot C,Carrat F,Poujol-Robert A,et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology,2012,56（1）:198-208.
[20] Floreani A,Cazzagon N,Martines D,et al. Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis. Dig Liver Dis,2011,43（11）:887-892.
[21] Wong VW,Vergniol J,Wong GL,et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology,2010,51（2）:454-462.
[22] Thiele M,Detlefsen S,Sevelsted Moller L,et al. Transient and 2-dimensional shear-wave elastography provide comparable assessment of alcoholic liver fibrosis and cirrhosis. Gastroenterology,2016,150（1）:123-133.
[23] 戴维佳,阮隽汤,汤伟亮,等. 肝脏瞬时弹性超声在药物性肝损伤患者肝纤维化诊断中的作用. 中华传染病杂志,2013,31（9）:529-532.
[24] Sini M,Sorbello O,Civolani A,et a1. Non-invasive assessment of hepatic fibrosis in a series of patients with Wilson’s Disease. Dig Liver Dis,2012,44（6）：487-491.
[25] Robic MA,Procopet B,Metivier S,et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease:a prospective study. J Hepatol,2011,55（5）:1017-1024.
[26] Kim MN,Kim SU,Kim BK,et al. Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis. Hepatology,2015,61（6）:1851-1859.
[27] Lee HW,Yoo EJ,Kim BK,et al. Prediction of development of liver-related events by transient elastography in hepatitis B patients with complete virological response on antiviral therapy. Am J Gastroenterol,2014,109（8）:1241-1249.
[28] Van Beers BE,Daire JL,Garteiser P. New imaging techniques for liver diseases. J Hepatol,2015,62（3）:690-700.
[29] Hagan M,Asrani SK,Talwalkar J. Non-invasive assessment of liver fibrosis and prognosis. Expert Rev Gastroenterol Hepatol,2015,9（10）:1251-1260.
[30] Castera L. Noninvasive assessment of liver fibrosis. Dig Dis,2015,33（4）:498-503.
[31] Castera L, Pinzani M. Biopsy and non-invasive methods for the diagnosis of liver fibrosis:does it take two to tango Gut,2010, 59（7）:861-866.
[32] Arena U,Vizzutti F,Corti G,et al.Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology,2008,47（2）:380-384.
[33] Millonig G,Reimann FM,Friedrich S,et al.Extrahepatic cholestasis increases liver stiffness（FibroScan） irrespective of fibrosis.Hepatology,2008,48（5）:1718-1723.
[34] Mederacke I,Wursthorn K,Kirschner J,et al. Food intake increases liver stiffness in patients with chronic or resolved hepatitis C virus infection. Liver Int,2009,29（10）:1500-1506.
[35] Arena U,Lupsor Platon M,Stasi C,et al. Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution. Hepatology,2013,58（1）:65-72.
[36] Berzigotti A,De Gottardi A,Vukotic R,et al. Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension. PLoS One,2013,8（3）:e58742.