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Non-invasive diagnosis and monitoring of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis
The Lancet Gastroenterology & Hepatology ( IF 35.7 ) Pub Date : 2023-04-13 , DOI: 10.1016/s2468-1253(23)00066-3
Monica A Tincopa 1 , Rohit Loomba 2
Affiliation  

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent form of chronic liver disease that poses challenges in diagnosis and risk stratification. Non-alcoholic steatohepatitis (NASH), the more progressive form of NAFLD, is particularly challenging to diagnose in the absence of histology. Liver biopsy is infrequently performed due to its invasive nature, potential for sampling error, and lack of inter-rater reliability. Non-invasive tests that can accurately identify patients with at-risk NASH (ie, individuals with biopsy-proven NASH with NAFLD activity score [NAS] ≥4 and fibrosis stage ≥2) are key tools to identify candidates for pharmacologic therapy in registrational trials for the treatment of NASH-related fibrosis. With emerging pharmacotherapy, non-invasive tests are required to track treatment response. Lastly, there is an unmet need for non-invasive tests to assess risk for clinical outcomes including progression to cirrhosis, hepatic decompensation, liver-related mortality, and overall mortality. In this Review we examine advances in non-invasive tests to diagnose and monitor NAFLD and NASH.



中文翻译:

非酒精性脂肪性肝病、非酒精性脂肪性肝炎的无创诊断与监测

非酒精性脂肪性肝病 (NAFLD) 是一种高度流行的慢性肝病,给诊断和风险分层带来了挑战。非酒精性脂肪性肝炎 (NASH) 是 NAFLD 的一种进展性形式,在缺乏组织学检查的情况下尤其难以诊断。由于肝活检具有侵入性、可能出现抽样错误以及缺乏评估者间的可靠性,因此很少进行肝活检。可以准确识别有风险 NASH患者的非侵入性测试(即,经活组织检查证实具有 NAFLD 活动评分的 NASH 患者[NAS] ≥ 4 和纤维化分期 ≥ 2) 是在治疗 NASH 相关纤维化的注册试验中确定药物治疗候选人的关键工具。随着新兴药物疗法的出现,需要进行非侵入性测试来追踪治疗反应。最后,对非侵入性测试评估临床结果风险的需求尚未得到满足,包括进展为肝硬化、肝功能失代偿、肝脏相关死亡率和总体死亡率。在这篇综述中,我们检查了用于诊断和监测 NAFLD 和 NASH 的非侵入性测试的进展。

更新日期:2023-04-13
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