无创性评估非酒精性脂肪性肝病患者肝纤维化应用进展*

doi:10.3969/j.issn.1672-5069.2025.03.040

摘要/Abstract

摘要： 非酒精性脂肪性肝病(NAFLD)患者肝纤维化与不良结局密切相关。早期干预肝纤维化进程有望改善疾病预后。肝穿刺活检是诊断肝纤维化分期的主要手段,但由于其侵入性、取样不一致和评估存在主观因素等,限制了该方法的广泛应用。近期涌现出一批新兴的无创性技术用于评估NAFLD患者肝纤维化,提高了检测便利性和重复性,本文就此展开了综述。

关键词: 非酒精性脂肪性肝病, 肝纤维化, 无创性标志物, 多组学, 诊断

Abstract: Liver fibrosis (LF) is closely related to poor outcomes in patients with non-alcoholic fatty liver disease (NAFLD), and early intervention is expected to improve prognosis of the disease. Percutaneous liver biopsy is the primary method for the diagnosis and staging of LF, but its wide application is limited as its invasiveness, sampling inconsistency and subjective evaluation. Recently, a lot of new non-invasive techniques have emerged for LF assessment, with advantage of convenience and repeatability. In this article, we provides a review on this topic.

Key words: Non-alcoholic fatty liver disease, Liver Fibrosis, Non-invasive Markers, Multiomics, Diagnosis

刘倩倩, 段志娇, 陈平. 无创性评估非酒精性脂肪性肝病患者肝纤维化应用进展^*[J]. 实用肝脏病杂志, 2025, 28(3): 477-480.

Liu Qianqian, Duan Zhijiao, Chen Ping. Non-invasive assessment of liver fibrosis in patients with non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2025, 28(3): 477-480.

参考文献

[1] Chalasani N, Younosi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 2017, 67(1): 328-357.
[2] Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 2023, 77(5): 1797-1835.
[3] Shili-Masmoudi S, Wong GL, Hiriart JB, et al. Liver stiffness measurement predicts long-term survival and complications in non-alcoholic fatty liver disease. Liver Int, 2019, 40(3): 581-589.
[4] Zhou JH, Cai JJ, She ZG, et al. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol, 2019, 25(11): 1307-1326.
[5] Younosi ZM, Stepanova M, Felix S, et al. The combination of the enhanced liver fibrosis and FIB-4 scores to determine significant fibrosis in patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther, 2023, 57(12): 1417-1422.
[6] Jang TY, Huang CF, Yeh ML, et al. Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein expression predicts disease severity in nonalcoholic steatohepatitis patients. Kaohsiung J Med Sci, 2021, 38(3): 261-267.
[7] Giraudi PJ, Salvoza N, Bonazza D, et al. Ficolin-2plasma level assesses liver fibrosis in non-alcoholic fatty liver disease. Int J Mol Sci, 2022, 23(5): 2813.
[8] Sripongpun P, Kim WR, Mannalithara A, et al. The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care. Hepatology, 2023, 77(1): 256-267.
[9] Lo GC, Besa C, King MJ, et al. Feasibility and reproducibility of liver surface nodularity quantification for the assessment of liver cirrhosis using CT and MRI. Eur J Radiol Open, 2017, 4: 95-100.
[10] Allan R, Thoirs K, Phillips M. Accuracy of ultrasound to identify chronic liver disease. World J Gastroenterol, 2010, 16(28): 3510-3520.
[11] Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScancontrolled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology, 2019, 156(6): 1717-1730.
[12] Mikolajavic I, Orlic L, Franjic N, et al. Transient elastography (FibroScan(©)) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand. World J Gastroenterol, 2016, 22(32): 7236-7251.
[13] Osman AM, El Shimy A, Abd El Aziz MM. 2D shear wave elastography (SWE) performance versus vibration-controlled transient elastography (VCTE/fibroscan) in the assessment of liver stiffness in chronic hepatitis. Insights Imaging, 2020, 11(1): 38.
[14] Barr RG, Ferraioli G, Palmeri ML, et al. Elastographyassessment of liver fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology, 2015, 276(3): 845-861.
[15] Clinical Practice Guideline Panel. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol, 2021, 75(3): 659-689.
[16] Barr RG, Wilson SR, Rubens D, et al. Update to the Society of Radiologists inultrasound liver elastography consensus statement. Radiology, 2020, 296(2): 263-274.
[17] Miao X, Sha T, Zhang W, et al. Liverfibrosis assessment by viewing sinusoidal capillarization: US molecular imaging versus two-dimensional shear-wave elastography in rats. Radiology, 2022, 304(2): 473-482.
[18] Selvaraj EA, Mózes FE, Ajmer Jayaswal AN, et al. Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis. J Hepatol, 2021, 75(4): 770-785.
[19] Loomba R, Cui J, Wolfson T, et al. Novel 3Dmagnetic resonance elastography for the noninvasive diagnosis of advanced fibrosis in NAFLD: A prospective study. Am J Gastroenterol, 2016, 111(7): 986-994.
[20] Newsome PN, Sasso M, Deeks JJ, et al. FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: a prospective derivation and global validation study. Lancet Gastroenterol Hepatol, 2020, 5(4): 362-373.
[21] Noureddin M, Truong E, Gornbein JA, et al. MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis. J Hepatol, 2021, 76(4): 781-787.
[22] Jung J, Loomba RR, Imajo K, et al. MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut, 2020, 70(10): 1946-1953.
[23] Kim BK, Tamaki N, Imajo K, et al. Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD. J Hepatol, 2022, 77(6): 1482-1490.
[24] Ohtani N, Kamiya T, Kawada N. Recent updates on the role of the gut-liver axis in the pathogenesis of NAFLD/NASH, HCC, and beyond. Hepatol Commun, 2023, 7(9): e0241.
[25] Boursier J, Mueller O, Barret M, et al. The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology, 2016, 63(3): 764-775.
[26] Iwaki M, Kessoku T, Ozaki A, et al. Gut microbiota composition associated with hepatic fibrosis in non-obese patients with non-alcoholic fatty liver disease. J Gastroenterol Hepatol, 2021, 36(8): 2275-2284.
[27] Vali Y, Lee J, Boursier J, et al. Biomarkers for staging fibrosis and non-alcoholic steatohepatitis in non-alcoholic fatty liver disease (the LITMUS project): a comparative diagnostic accuracy study. Lancet Gastroenterol Hepatol, 2023, 8(8): 714-725.
[28] Govaere O, Hasoon M, Alexander L, et al. A proteo-transcriptomic map of non-alcoholic fatty liver disease signatures. Nat Metab, 2023, 5(4): 572-578.
[29] Caussy C, Ajmera VH, Puri P, et al. Serum metabolites detect the presence of advanced fibrosis in derivation and validation cohorts of patients with non-alcoholic fatty liver disease. Gut, 2018, 68(10): 1884-1892.
[30] Smirnova E, Muthiah MD, Narayan N, et al. Metabolic reprogramming of the intestinal microbiome with functional bile acid changes underlie the development of NAFLD. Hepatology, 2022, 76(6): 1811-1824.
[31] Kasai Y, Kessoku T, Tanaka K, et al. Association ofserum and fecal bile acid patterns with liver fibrosis in biopsy-proven nonalcoholic fatty liver disease: An observational study. Clin Transl Gastroenterol, 2022, 13(7): e00503.
[32] Masarone M, Troisi J, Aglitti A, et al. Untargeted metabolomics as a diagnostic tool in NAFLD: discrimination of steatosis, steatohepatitis and cirrhosis. Metabolomics, 2021, 17(2): 12.
[33] Pennisi G, Pipitone RM, Cammà C, et al. PNPLA3 rs738409 C>Gvariant predicts fibrosis progression by noninvasive tools in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 2020, 19(9): 1979-1981.
[34] Grimaudo S, Pipitone RM, Pennisi G, et al. Associationbetween PNPLA3 rs738409 C>G variant and liver-related outcomes in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 2019, 18(4): 935-944,e3.
[35] Liu WY, Zheng KI, Pan XY, et al. Effect of PNPLA3 polymorphism on diagnostic performance of various noninvasive markers for diagnosing and staging nonalcoholic fatty liver disease. J Gastroenterol Hepatol, 2019, 35(6): 1057-1064.
[36] Liu YL, Reeves HL, Burt AD, et al. TM6SF2 rs58542926 influences hepatic fibrosis progression in patients with non-alcoholic fatty liver disease. Nat Commun, 2014, 5: 4309.
[37] Sliz E, Sebert S, Würtz P, et al. NAFLD risk alleles in PNPLA3, TM6SF2, GCKR and LYPLAL1 show divergent metabolic effects. Hum Mol Genet, 2018, 27(12): 2214-2223.
[38] Johnson ND, Wu X, Still CD, et al. Differential DNA methylation and changing cell-type proportions as fibrotic stage progresses in NAFLD. Clin Epigenetics, 2021, 13(1): 152.
[39] Johnson K, Leary PJ, Govare O, et al. Increased serum miR-193a-5p during non-alcoholic fatty liver disease progression: Diagnostic and mechanistic relevance. JHEP Rep, 2021, 4(2): 100409.
[40] Wang K, Lu X, Zhou H, et al. Deep learningradiomics of shear wave elastography significantly improved diagnostic performance for assessing liver fibrosis in chronic hepatitis B: a prospective multicentre study. Gut, 2018, 68(4): 729-741.
[41] Yasada K, Akai H, Kunimatsu A, et al. Liverfibrosis: Deep convolutional neural network for staging by using gadoxetic acid-enhanced hepatobiliary phase MR images. Radiology, 2017, 287(1): 146-155.

无创性评估非酒精性脂肪性肝病患者肝纤维化应用进展^*

Non-invasive assessment of liver fibrosis in patients with non-alcoholic fatty liver disease

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