非侵入性方法評價肝纖維化_《中國普外基礎與臨床雜志》

作者：

陳光文 , 宋彬

四川大學華西醫院放射科（成都 610041）;

關鍵詞：

肝纖維化血清標志物超聲斷層攝影術/X線計算機磁共振成像

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的綜合評價非侵入性評價方法在肝纖維化診斷中的臨床應用價值和存在的問題。方法通過總結血清纖維化標志物、超聲、CT和MRI在評價肝纖維化中的應用現狀及最新進展，以評價這些非侵入性方法的應用價值和存在的問題。結果各種非侵入性評價方法除了能診斷肝纖維化外，還能對肝纖維化的嚴重程度進行分級；但目前的非侵入性方法還不能有效監測肝纖維化隨時間的演變情況和對治療的反應。結論非侵入性評價方法在肝纖維化的診斷和嚴重程度分級方面發揮重要作用，可以在一定程度上代替組織活檢。

引用本文： 陳光文,宋彬. 非侵入性方法評價肝纖維化. 中國普外基礎與臨床雜志, 2009, 16(5): 414-417. doi: 復制

1.	Standish RA, Cholongitas E, Dhillon A, et al. An appraisal of the histopathological assessment of liver fibrosis [Ｊ]. Gut, 2006; 55(4): 569-578.
2.	Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology [Ｊ]. Gut, 1999; 45(Suppl 4): Ⅳ1-Ⅳ11.
3.	Pinzani M. Non-invasive evaluation of hepatic fibrosis: don’t count your chickens before they’re hatched [Ｊ]. Gut, 2006; 55(3): 310-312.
4.	Sebastiani G, Vario A, Guido M, et al. Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B [Ｊ]. World J Gastroenterol, 2007; 13(4): 525-531.
5.	Guha IN, Parkes J, Roderick PR, et al. Non-invasive markers associated with liver fibrosis in non-alcoholic fatty liver disease [Ｊ]. Gut, 2006; 55(11): 1650-1660.
6.	Poynard T, Morra R, Halfon P, et al. Meta-analyses of FibroTest diagnostic value in chronic liver disease [Ｊ]. BMC Gastroenterol, 2007; 7: 40.
7.	Rossi E, Adams LA, Bulsara M, et al. Assessing liver fibrosis with serum marker models [Ｊ]. Clin Biochem Rev, 2007; 28(1): 3-10.
8.	Halfon P, Bourlière M, Pénaranda G, et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus [Ｊ]. Comp Hepatol, 2005; 4: 6.
9.	Rosenberg WM, Voelker M, Thiel R, et al. Serum markers detect the presence of liver fibrosis: a cohort study [Ｊ]. Gastroenterology, 2004; 127(6): 1704-1713.
10.	Shen L, Li JQ, Zeng MD, et al. C Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis [Ｊ]. World J Gastroenterol, 2006; 12(8): 1292-1295.
11.	Blomley MJ, Lim AK, Harvey CJ, et al. Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study [Ｊ]. Gut, 2003; 52(8): 1188-1193.
12.	Lim AK, Taylor-Robinson SD, Patel N, et al. Hepatic vein transit times using a microbubble agent can predict disease severity non-invasively in patients with hepatitis C [Ｊ]. Gut, 2005; 54(1): 128-133.
13.	羅小華, 宋彬, 陳衛霞. 慢性乙型肝炎CT表現與病情程度的關系 [Ｊ]. 中華肝臟病雜志, 2005; 13（3）: 190-193.
14.	童隆正, 王新光, 賀文. 關于CT圖像肝纖維化評定標準的研究 [Ｊ]. 醫療設備信息, 2001; 12(16): 9-11.
15.	宋彬. CT灌注成像的原理、技術及在腹部影像診斷中的應用 [Ｊ]. 中國普外基礎與臨床雜志, 2004; 11(2): 171-174.
16.	吳苾, 宋彬. 影像學新技術在消化系統的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(2): 222-229.
17.	江利, 楊建勇, 楊旭峰, 等. 肝臟CT灌注成像技術及其在肝硬化中的初步應用 [Ｊ]. 臨床放射學雜志, 2004; 23(3): 214-217.
18.	Guan S, Zhao WD, Zhou KR, et al. CT perfusion at early stage of hepatic diffuse disease [Ｊ]. World J Gastroenterol, 2005; 11(22): 3465-3467.
19.	上海市肝纖維化課題協作組. 肝纖維化的CT、 MR 診斷初步探討 [Ｊ]. 上海醫學, 2002; 25（4）: 210-213.
20.	Ito K, Mitchell DG, Hann HW, et al. Viral-induced cirrhosis: grading of severity using MR imaging [Ｊ]. AJR Am J Roentgenol, 1999; 173(3): 591-596.
21.	陳克敏, 鐘亮, 柴維敏，等. 肝纖維化門脈血流的磁共振相位對比法測定 [Ｊ]. 臨床放射學雜志, 2001; 20(1): 53-55.
22.	Aguirre DA, Behling CA, Alpert E, et al. Liver fibrosis: noninvasive diagnosis with double contrast material-enhanced MR imaging [Ｊ]. Radiology, 2006; 239(2): 425-437.
23.	王秋實, 郭啟勇, 梁長虹, 等. MR彌散加權成像評價肝纖維化的初步實驗研究 [Ｊ].解剖學研究, 2007; 29(3): 212-216.
24.	管生, 趙衛東, 周康榮, 等. 磁共振功能彌散成像對肝臟早期彌漫性病變診斷價值的實驗研究 [Ｊ]. 中華肝臟病雜志, 2005; 13（7）: 524-527.
25.	沈文, 尹建忠, 張龍江, 等. 肝纖維化和肝硬化的MR擴散成像及與病理對照、CT灌注參數的相關性研究 [Ｊ]. 臨床放射學雜志, 2007; 26(10): 1000-1004.
26.	Aubé C, Racineux PX, Lebigot J, et al. Diagnosis and quantification of hepatic fibrosis with diffusion weighted MR imaging: preliminary results [Ｊ]. J Radiol, 2004; 85(3): 301-306.
27.	吳苾, 宋彬, 楊洋. 肝臟31P-MR波譜成像的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(6): 624-627.
28.	崔恩銘, 譚理連, 李志銘, 等. 健康成人肝臟31P-MR 波譜研究 [Ｊ]. 放射學實踐, 2007; 22（11）: 1189-1192.
29.	崔恩銘, 譚理連, 李志銘, 等. 慢性乙型肝炎患者31P MRS 與血清肝功能相關性研究 [Ｊ]. 中國臨床醫學影像雜志, 2007; 18（11）: 789-792.
30.	張藝軍, 郭玉峰, 周懷琪, 等. 1HMRS在定性診斷乙肝后早期肝硬化中的初步研究 [Ｊ]. 現代生物醫學進展, 2007; 7（7）: 1061-1064.
31.	Xu L, Gao PY. “Palpation by imaging”: magnetic resonance elastography [Ｊ]. Chin Med Sci J, 2006; 21(4): 281-286.
32.	Cobbold JF, Morin S, Taylor-Robinson SD. Transient elastography for the assessment of chronic liver disease: ready for the clinic [Ｊ]. World J Gastroenterol, 2007; 13(36): 4791-4797.
33.	Foucher J, Chanteloup E, Vergniol J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study [Ｊ]. Gut, 2006; 55(3): 403-408.
34.	Moreno-Otero R, Trapero-Marugan M, Mendoza J. Liver fibrosis assessment by transient elastography in hepatitis C patients with normal alanine aminotransferase [Ｊ]. Gut, 2006; 55(7): 1055-1056.
35.	Takeda T, Yasuda T, Nakayama Y, et al. Usefulness of noninvasive transient elastography for assessment of liver fibrosis stage in chronic hepatitis C [Ｊ]. World J Gastroenterol, 2006; 12(48): 7768-7773.
36.	Fraquelli M, Rigamonti C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease [Ｊ]. Gut, 2007; 56(7): 968-973.

1. Standish RA, Cholongitas E, Dhillon A, et al. An appraisal of the histopathological assessment of liver fibrosis [Ｊ]. Gut, 2006; 55(4): 569-578.
2. Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology [Ｊ]. Gut, 1999; 45(Suppl 4): Ⅳ1-Ⅳ11.
3. Pinzani M. Non-invasive evaluation of hepatic fibrosis: don’t count your chickens before they’re hatched [Ｊ]. Gut, 2006; 55(3): 310-312.
4. Sebastiani G, Vario A, Guido M, et al. Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B [Ｊ]. World J Gastroenterol, 2007; 13(4): 525-531.
5. Guha IN, Parkes J, Roderick PR, et al. Non-invasive markers associated with liver fibrosis in non-alcoholic fatty liver disease [Ｊ]. Gut, 2006; 55(11): 1650-1660.
6. Poynard T, Morra R, Halfon P, et al. Meta-analyses of FibroTest diagnostic value in chronic liver disease [Ｊ]. BMC Gastroenterol, 2007; 7: 40.
7. Rossi E, Adams LA, Bulsara M, et al. Assessing liver fibrosis with serum marker models [Ｊ]. Clin Biochem Rev, 2007; 28(1): 3-10.
8. Halfon P, Bourlière M, Pénaranda G, et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus [Ｊ]. Comp Hepatol, 2005; 4: 6.
9. Rosenberg WM, Voelker M, Thiel R, et al. Serum markers detect the presence of liver fibrosis: a cohort study [Ｊ]. Gastroenterology, 2004; 127(6): 1704-1713.
10. Shen L, Li JQ, Zeng MD, et al. C Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis [Ｊ]. World J Gastroenterol, 2006; 12(8): 1292-1295.
11. Blomley MJ, Lim AK, Harvey CJ, et al. Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study [Ｊ]. Gut, 2003; 52(8): 1188-1193.
12. Lim AK, Taylor-Robinson SD, Patel N, et al. Hepatic vein transit times using a microbubble agent can predict disease severity non-invasively in patients with hepatitis C [Ｊ]. Gut, 2005; 54(1): 128-133.
13. 羅小華, 宋彬, 陳衛霞. 慢性乙型肝炎CT表現與病情程度的關系 [Ｊ]. 中華肝臟病雜志, 2005; 13（3）: 190-193.
14. 童隆正, 王新光, 賀文. 關于CT圖像肝纖維化評定標準的研究 [Ｊ]. 醫療設備信息, 2001; 12(16): 9-11.
15. 宋彬. CT灌注成像的原理、技術及在腹部影像診斷中的應用 [Ｊ]. 中國普外基礎與臨床雜志, 2004; 11(2): 171-174.
16. 吳苾, 宋彬. 影像學新技術在消化系統的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(2): 222-229.
17. 江利, 楊建勇, 楊旭峰, 等. 肝臟CT灌注成像技術及其在肝硬化中的初步應用 [Ｊ]. 臨床放射學雜志, 2004; 23(3): 214-217.
18. Guan S, Zhao WD, Zhou KR, et al. CT perfusion at early stage of hepatic diffuse disease [Ｊ]. World J Gastroenterol, 2005; 11(22): 3465-3467.
19. 上海市肝纖維化課題協作組. 肝纖維化的CT、 MR 診斷初步探討 [Ｊ]. 上海醫學, 2002; 25（4）: 210-213.
20. Ito K, Mitchell DG, Hann HW, et al. Viral-induced cirrhosis: grading of severity using MR imaging [Ｊ]. AJR Am J Roentgenol, 1999; 173(3): 591-596.
21. 陳克敏, 鐘亮, 柴維敏，等. 肝纖維化門脈血流的磁共振相位對比法測定 [Ｊ]. 臨床放射學雜志, 2001; 20(1): 53-55.
22. Aguirre DA, Behling CA, Alpert E, et al. Liver fibrosis: noninvasive diagnosis with double contrast material-enhanced MR imaging [Ｊ]. Radiology, 2006; 239(2): 425-437.
23. 王秋實, 郭啟勇, 梁長虹, 等. MR彌散加權成像評價肝纖維化的初步實驗研究 [Ｊ].解剖學研究, 2007; 29(3): 212-216.
24. 管生, 趙衛東, 周康榮, 等. 磁共振功能彌散成像對肝臟早期彌漫性病變診斷價值的實驗研究 [Ｊ]. 中華肝臟病雜志, 2005; 13（7）: 524-527.
25. 沈文, 尹建忠, 張龍江, 等. 肝纖維化和肝硬化的MR擴散成像及與病理對照、CT灌注參數的相關性研究 [Ｊ]. 臨床放射學雜志, 2007; 26(10): 1000-1004.
26. Aubé C, Racineux PX, Lebigot J, et al. Diagnosis and quantification of hepatic fibrosis with diffusion weighted MR imaging: preliminary results [Ｊ]. J Radiol, 2004; 85(3): 301-306.
27. 吳苾, 宋彬, 楊洋. 肝臟31P-MR波譜成像的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(6): 624-627.
28. 崔恩銘, 譚理連, 李志銘, 等. 健康成人肝臟31P-MR 波譜研究 [Ｊ]. 放射學實踐, 2007; 22（11）: 1189-1192.
29. 崔恩銘, 譚理連, 李志銘, 等. 慢性乙型肝炎患者31P MRS 與血清肝功能相關性研究 [Ｊ]. 中國臨床醫學影像雜志, 2007; 18（11）: 789-792.
30. 張藝軍, 郭玉峰, 周懷琪, 等. 1HMRS在定性診斷乙肝后早期肝硬化中的初步研究 [Ｊ]. 現代生物醫學進展, 2007; 7（7）: 1061-1064.
31. Xu L, Gao PY. “Palpation by imaging”: magnetic resonance elastography [Ｊ]. Chin Med Sci J, 2006; 21(4): 281-286.
32. Cobbold JF, Morin S, Taylor-Robinson SD. Transient elastography for the assessment of chronic liver disease: ready for the clinic [Ｊ]. World J Gastroenterol, 2007; 13(36): 4791-4797.
33. Foucher J, Chanteloup E, Vergniol J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study [Ｊ]. Gut, 2006; 55(3): 403-408.
34. Moreno-Otero R, Trapero-Marugan M, Mendoza J. Liver fibrosis assessment by transient elastography in hepatitis C patients with normal alanine aminotransferase [Ｊ]. Gut, 2006; 55(7): 1055-1056.
35. Takeda T, Yasuda T, Nakayama Y, et al. Usefulness of noninvasive transient elastography for assessment of liver fibrosis stage in chronic hepatitis C [Ｊ]. World J Gastroenterol, 2006; 12(48): 7768-7773.
36. Fraquelli M, Rigamonti C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease [Ｊ]. Gut, 2007; 56(7): 968-973.

《中國普外基礎與臨床雜志》

非侵入性方法評價肝纖維化

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

《中國普外基礎與臨床雜志》

非侵入性方法評價肝纖維化

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料