Cirrhosis, highly prevalent worldwide, develops after years of hepatic inflammation triggering progressive fibrosis. Currently, the main etiologies of cirrhosis are non-alcoholic fatty liver disease and alcohol-related liver disease, although chronic hepatitis B and C infections are still major etiological factors in some areas of the world. Recent studies have shown that liver fibrosis can be assessed with relatively high accuracy noninvasively by serological tests, transient elastography, and radiological methods. These modalities may be utilized for screening for liver fibrosis in at-risk populations. Thus far, a limited number of population-based studies using noninvasive tests in different areas of the world indicate that a significant percentage of subjects without known liver disease (around 5% in general populations and a higher rate −18% to 27%-in populations with risk factors for liver disease) have significant undetected liver fibrosis or established cirrhosis. Larger international studies are required to show the harms and benefits before concluding that screening for liver fibrosis should be applied to populations at risk for chronic liver diseases. Screening for liver fibrosis has the potential for changing the current approach from diagnosing chronic liver diseases late when patients have already developed complications of cirrhosis to diagnosing liver fibrosis in asymptomatic subjects providing the opportunity of preventing disease progression.

中文翻译：

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肝纤维化人群筛查：慢性肝病的早期诊断和干预

肝硬化在世界范围内高度流行，是在多年的肝脏炎症引发进行性纤维化后发展起来的。目前，肝硬化的主要病因是非酒精性脂肪性肝病和酒精相关性肝病，尽管慢性乙型和丙型肝炎感染仍然是世界某些地区的主要病因。最近的研究表明，可以通过血清学检测、瞬时弹性成像和放射学方法以相对较高的准确度无创评估肝纤维化。这些方式可用于筛查高危人群的肝纤维化。迄今，在世界不同地区使用无创检测的数量有限的基于人群的研究表明，很大一部分没有已知肝病的受试者（在一般人群中约为 5%，在有风险的人群中比例较高，为 -18% 至 27%）肝病因素）有明显的未检测到的肝纤维化或已确定的肝硬化。在得出结论认为肝纤维化筛查应适用于有慢性肝病风险的人群之前，需要进行更大规模的国际研究来显示其危害和益处。