Transient elastography and other noninvasive tests to assess hepatic fibrosis in patients with viral hepatitis

被引:135
作者
Castera, Laurent [1 ]
机构
[1] Bordeaux Univ Hosp, Dept Hepatol, Hop St Andre & Haut Leveque, Bordeaux, France
关键词
liver biopsy; liver fibrosis; noninvasive; serum markers; transient elastography; LIVER STIFFNESS MEASUREMENT; SERUM HYALURONIC-ACID; STEPWISE COMBINATION ALGORITHMS; SIGNIFICANT PORTAL-HYPERTENSION; MARKERS FIBROTEST-ACTITEST; STANDARD LABORATORY TESTS; C-VIRUS; BIOCHEMICAL MARKERS; ESOPHAGEAL-VARICES; DIAGNOSTIC-ACCURACY;
D O I
10.1111/j.1365-2893.2009.01087.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The limitations of liver biopsy (invasive procedure, sampling errors, inter-observer variability and nondynamic fibrosis evaluation) have stimulated the search for noninvasive approaches for the assessment of liver fibrosis in patients with viral hepatitis. A variety of methods including the measurement of liver stiffness, using transient elastography, and serum markers, ranging from routine laboratory tests to more complex algorithms or indices combining the results of panels of markers, have been proposed. Among serum indices, Fibrotest has been the most extensively studied and validated. Transient elastography appears as a promising method but has been mostly validated in chronic hepatitis C with performance equivalent to that of serum markers for the diagnosis of significant fibrosis. The combination of both approaches as first-line assessment of liver fibrosis could avoid the performance of liver biopsy in the majority of patients with chronic hepatitis C, a strategy that deserves further evaluation in patients with hepatitis B or HIV-HCV coinfection. Transient elastography also appears to be an excellent tool for early detection of cirrhosis and may have prognostic value in this setting. Guidelines are now awaited for the use of noninvasive methods in clinical practice.
引用
收藏
页码:300 / 314
页数:15
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