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Non-invasive diagnosis of patients with ‘at-risk’ NAFLD : only fibrosis counts?
Gut ( IF 23.0 ) Pub Date : 2020-03-27 , DOI: 10.1136/gutjnl-2020-320785
Andreas Geier 1 , Jerome Boursier 2
Affiliation  

In Gut , Loomba and Adams refer to the recent advances in non-invasive assessment of hepatic fibrosis.1 Not surprisingly, many recent studies in the field were conducted in patients at risk or with clinically diagnosed non-alcoholic fatty liver disease (NAFLD). The implications of non-invasive testing are particularly far reaching in this group of patients since this disease affects 25% of Western populations. The principal need to identify the small subset of NAFLD patients at-risk of progressive disease and liver-related outcomes is obvious. Recent retrospective longitudinal studies have shown that non-alcoholic steatohepatitis (NASH) is not an independent predictor of liver-related complication or mortality in NAFLD.2 3 NASH is a risk factor of fibrosis progression rather than an immediate risk of liver related complication and therefore positions at a lower prognostic significance in the hierarchical model of NAFLD.4 The diagnosis of NASH still requires a liver biopsy, a procedure not suitable for the very large NAFLD population because it is invasive and not widely accepted among non-specialised physicians and patients. No non-invasive test (NIT) has so far achieved enough accuracy and validation for the non-invasive diagnosis of NASH. One explanation is that most of the known candidate blood markers for NASH are not specific of the liver and could be produced by other organs, especially the expanded adipose tissue observed in NAFLD. Moreover, liver biopsy results are limited by a fairly high discordance …

中文翻译:

“高危” NAFLD 患者的非侵入性诊断:仅纤维化计数?

在 Gut 一书中,Loomba 和 Adams 提到了肝纤维化非侵入性评估的最新进展。1 毫不奇怪,该领域的许多近期研究都是针对有风险或临床诊断为非酒精性脂肪肝 (NAFLD) 的患者进行的。由于这种疾病影响了 25% 的西方人群,因此非侵入性检测对这组患者的影响尤其深远。确定有进展性疾病和肝脏相关结果风险的一小部分 NAFLD 患者的主要需求是显而易见的。最近的回顾性纵向研究表明,非酒精性脂肪性肝炎 (NASH) 不是 NAFLD 肝脏相关并发症或死亡率的独立预测因素。2 3 NASH 是纤维化进展的危险因素,而不是肝脏相关并发症的直接风险,因此在 NAFLD 的分层模型中处于较低的预后意义。4 NASH 的诊断仍然需要肝活检,这种程序不适合非常大的 NAFLD 人群,因为它具有侵入性,并且未被非专科医师和患者广泛接受。迄今为止,没有一种非侵入性测试 (NIT) 能够实现对 NASH 的非侵入性诊断足够的准确性和验证。一种解释是,大多数已知的 NASH 候选血液标志物不是肝脏特异性的,可能由其他器官产生,尤其是在 NAFLD 中观察到的膨胀脂肪组织。此外,肝活检结果受到相当高的不一致的限制…… 这种手术不适合非常大的 NAFLD 人群,因为它具有侵入性,并且未被非专科医师和患者广泛接受。迄今为止,没有一种非侵入性测试 (NIT) 能够实现对 NASH 的非侵入性诊断足够的准确性和验证。一种解释是,大多数已知的 NASH 候选血液标志物不是肝脏特异性的,可能由其他器官产生,尤其是在 NAFLD 中观察到的膨胀脂肪组织。此外,肝活检结果受到相当高的不一致的限制…… 这种手术不适合非常大的 NAFLD 人群,因为它具有侵入性,并且未被非专科医师和患者广泛接受。迄今为止,没有一种非侵入性测试 (NIT) 能够实现对 NASH 的非侵入性诊断足够的准确性和验证。一种解释是,大多数已知的 NASH 候选血液标志物不是肝脏特异性的,可能由其他器官产生,尤其是在 NAFLD 中观察到的膨胀脂肪组织。此外,肝活检结果受到相当高的不一致的限制…… 一种解释是,大多数已知的 NASH 候选血液标志物不是肝脏特异性的,可能由其他器官产生,尤其是在 NAFLD 中观察到的膨胀脂肪组织。此外,肝活检结果受到相当高的不一致的限制…… 一种解释是,大多数已知的 NASH 候选血液标志物不是肝脏特异性的,可能由其他器官产生,尤其是在 NAFLD 中观察到的膨胀脂肪组织。此外,肝活检结果受到相当高的不一致的限制……
更新日期:2020-03-27
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