• 四川大學(xué)華西醫(yī)院放射科（成都 610041）;

目的  綜合評(píng)價(jià)非侵入性評(píng)價(jià)方法在肝纖維化診斷中的臨床應(yīng)用價(jià)值和存在的問題。方法  通過總結(jié)血清纖維化標(biāo)志物、超聲、CT和MRI在評(píng)價(jià)肝纖維化中的應(yīng)用現(xiàn)狀及最新進(jìn)展，以評(píng)價(jià)這些非侵入性方法的應(yīng)用價(jià)值和存在的問題。 結(jié)果  各種非侵入性評(píng)價(jià)方法除了能診斷肝纖維化外，還能對(duì)肝纖維化的嚴(yán)重程度進(jìn)行分級(jí)； 但目前的非侵入性方法還不能有效監(jiān)測(cè)肝纖維化隨時(shí)間的演變情況和對(duì)治療的反應(yīng)。結(jié)論  非侵入性評(píng)價(jià)方法在肝纖維化的診斷和嚴(yán)重程度分級(jí)方面發(fā)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(píng)價(jià)肝纖維化. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(5): 414-417. doi: 復(fù)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(wèi)霞. 慢性乙型肝炎CT表現(xiàn)與病情程度的關(guān)系 [Ｊ]. 中華肝臟病雜志, 2005; 13（3）: 190-193.
14. 童隆正, 王新光, 賀文. 關(guān)于CT圖像肝纖維化評(píng)定標(biāo)準(zhǔn)的研究 [Ｊ]. 醫(yī)療設(shè)備信息, 2001; 12(16): 9-11.
15. 宋彬. CT灌注成像的原理、技術(shù)及在腹部影像診斷中的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004; 11(2): 171-174.
16. 吳苾, 宋彬. 影像學(xué)新技術(shù)在消化系統(tǒng)的臨床應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)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(shù)及其在肝硬化中的初步應(yīng)用 [Ｊ]. 臨床放射學(xué)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(xié)作組. 肝纖維化的CT、 MR 診斷初步探討 [Ｊ]. 上海醫(yī)學(xué), 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(duì)比法測(cè)定 [Ｊ]. 臨床放射學(xué)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(shí), 郭啟勇, 梁長(zhǎng)虹, 等. MR彌散加權(quán)成像評(píng)價(jià)肝纖維化的初步實(shí)驗(yàn)研究 [Ｊ].解剖學(xué)研究, 2007; 29(3): 212-216.
24. 管生, 趙衛(wèi)東, 周康榮, 等. 磁共振功能彌散成像對(duì)肝臟早期彌漫性病變?cè)\斷價(jià)值的實(shí)驗(yàn)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(kuò)散成像及與病理對(duì)照、CT灌注參數(shù)的相關(guān)性研究 [Ｊ]. 臨床放射學(xué)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(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)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(xué)實(shí)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(guān)性研究 [Ｊ]. 中國(guó)臨床醫(yī)學(xué)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(xiàn)代生物醫(yī)學(xué)進(jìn)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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. 羅小華, 宋彬, 陳衛(wèi)霞. 慢性乙型肝炎CT表現(xiàn)與病情程度的關(guān)系 [Ｊ]. 中華肝臟病雜志, 2005; 13（3）: 190-193.
  14. 14. 童隆正, 王新光, 賀文. 關(guān)于CT圖像肝纖維化評(píng)定標(biāo)準(zhǔn)的研究 [Ｊ]. 醫(yī)療設(shè)備信息, 2001; 12(16): 9-11.
  15. 15. 宋彬. CT灌注成像的原理、技術(shù)及在腹部影像診斷中的應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004; 11(2): 171-174.
  16. 16. 吳苾, 宋彬. 影像學(xué)新技術(shù)在消化系統(tǒng)的臨床應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 222-229.
  17. 17. 江利, 楊建勇, 楊旭峰, 等. 肝臟CT灌注成像技術(shù)及其在肝硬化中的初步應(yīng)用 [Ｊ]. 臨床放射學(xué)雜志, 2004; 23(3): 214-217.
  18. 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. 19. 上海市肝纖維化課題協(xié)作組. 肝纖維化的CT、 MR 診斷初步探討 [Ｊ]. 上海醫(yī)學(xué), 2002; 25（4）: 210-213.
  20. 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. 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(duì)比法測(cè)定 [Ｊ]. 臨床放射學(xué)雜志, 2001; 20(1): 53-55.
  22. 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. 23. 王秋實(shí), 郭啟勇, 梁長(zhǎng)虹, 等. MR彌散加權(quán)成像評(píng)價(jià)肝纖維化的初步實(shí)驗(yàn)研究 [Ｊ].解剖學(xué)研究, 2007; 29(3): 212-216.
  24. 24. 管生, 趙衛(wèi)東, 周康榮, 等. 磁共振功能彌散成像對(duì)肝臟早期彌漫性病變?cè)\斷價(jià)值的實(shí)驗(yàn)研究 [Ｊ]. 中華肝臟病雜志, 2005; 13（7）: 524-527.
  25. 25. 沈文, 尹建忠, 張龍江, 等. 肝纖維化和肝硬化的MR擴(kuò)散成像及與病理對(duì)照、CT灌注參數(shù)的相關(guān)性研究 [Ｊ]. 臨床放射學(xué)雜志, 2007; 26(10): 1000-1004.
  26. 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. 27. 吳苾, 宋彬, 楊洋. 肝臟31P-MR波譜成像的臨床應(yīng)用 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2005; 12(6): 624-627.
  28. 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(xué)實(shí)踐, 2007; 22（11）: 1189-1192.
  29. 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(guān)性研究 [Ｊ]. 中國(guó)臨床醫(yī)學(xué)影像雜志, 2007; 18（11）: 789-792.
  30. 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(xiàn)代生物醫(yī)學(xué)進(jìn)展, 2007; 7（7）: 1061-1064.
  31. 31. Xu L, Gao PY. “Palpation by imaging”: magnetic resonance elastography [Ｊ]. Chin Med Sci J, 2006; 21(4): 281-286.
  32. 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. 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. 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. 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. 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.