• 1. 四川大學華西臨床醫(yī)學院（成都 610041）2. 四川大學華西醫(yī)院中國循證醫(yī)學中心;

肝纖維化是指在各種慢性肝病時，肝細胞發(fā)生持續(xù)、反復(fù)的壞死或炎癥刺激，導(dǎo)致機體發(fā)生修復(fù)反應(yīng)，結(jié)果是大量纖維增生同時伴有纖維降解相對或絕對不足，細胞外基質(zhì)在肝內(nèi)大量沉積。肝纖維化的及時早期診斷和治療，對于肝病診治有重要價值。一個合理完整的肝纖維化的診斷模式應(yīng)包括臨床、病理組織學、影像學、血清生化標志物的綜合診斷。長期以來肝活檢一直是診斷肝纖維化的“金標準”，也是其他無創(chuàng)性肝纖維化診斷試驗的參考標準，但肝活檢有創(chuàng)傷性，在臨床實踐中不僅一次肝穿較難獲得，二次肝穿更難實現(xiàn)。無創(chuàng)性診斷中，肝纖維化并無特殊的臨床癥狀和體征，單項的血清生化指標檢測診斷的敏感性和特異性還很差，影像學檢查缺乏特異性，血清生化標志物數(shù)學診斷模式FibroTest雖有較好的診斷準確性，但其計算頗為復(fù)雜而難以普及推廣。迄今尚無充足的證據(jù)證明可取代肝穿的“金標準”，因此如何均衡各種指標的利弊，篩選最佳組合，簡化計算步驟，降低費用，減少肝穿，尋找新的更特異敏感的標志物，仍是我們今后所要努力的。

引用本文： 張雅,劉關(guān)鍵. 慢性肝病肝纖維化的診斷. 中國循證醫(yī)學雜志, 2007, 07(4): 316-320. doi: 復(fù)制

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1. Wang BE, Zhang DF, editor-in-chief. Modern study of liver disease. 1rst edition. BeiJing: Science Press, 2003. p. 513.
2. Luo KX, editor in chief. Hepatitis B - basic and clinical. 1rst edition. BeiJing: People’s Health Press, 1997, p. 370.
3. Lang JM, editor in chief. Clinical Immunology diagnosis. 1rst edition. GuangZhou: Guangdong Science and Technology Press, 2003, p. 61.
4. Wang BE. Current trends in the study of liver fibrosis. Chinese magazine liver disease, 2006, 14(3): 167-168.
5. May 1995, the Fifth National Conference on parasitic diseases discuss infectious diseases. Viral hepatitis Control Program (Tentative) . Chinese Journal of Infectious Diseases, 1995, 13(4): 241-247.
6. Xian. the Chinese Medical Association in September 2000 credits infectious and parasitic diseases, liver diseases jointly amend credit. Viral hepatitis Control Program (Tentative). Chinese magazine liver disease, 2000, 8(6): 324-329.
7. Chinese chemical fiber liver Institute of liver disease. Clinical assessment and diagnosis of liver fibrosis consensus. Chinese magazine liver disease, 2002, 10(5): 327-328.
8. Quan QZ, Sun ZQ, Wang YJ, editor in chief. New Liver Diseases. JiLan: Shandong Science and Technology Press, 2003, 338.
9. Luo JW, Shao JH, Bai J, et al. Transient elastography imaging for the non-invasive evaluation of liver fibrosis. Chinese magazine liver disease, 2006, 14(5): 395-397.
10. 王寶恩, 張定鳳 主編. 現(xiàn)代肝臟病學. 第1版. 北京: 科學出版社, 2003, p. 513.
11. 駱抗先. 主編. 乙型肝炎－基礎(chǔ)和臨床. 第一版. 北京: 人民衛(wèi)生出版社, 1997, p. 370.
12. 朗江明. 主編. 臨床免疫診斷學. 第一版. 廣州: 廣東科技出版社, 2003, p. 61.
13. http://www.beixi.com/cn/the.htm.
14. 王寶恩. 當前肝纖維化研究的若干動向. 中華肝臟病雜志, 2006, 14(3): 167~168.
15. 1995年5月北京第五次全國傳染病寄生蟲病學術(shù)會議討論修訂. 病毒性肝炎防治方案（試行） . 中華傳染病雜志, 1995, 13(4): 241~247.
16. Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol, 1991, 13: 372.
17. Halfon P,Bourliere M, Penaranda G, et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus. Comparative hepatology, 2005, 4:6 dio: 10.1 186/1476-5926-4-6.
18. Montazeri G, Estakhri A, Mohamadnejad M, et al. Serum hyaluronate as a non-invasive marker of hepatic fibrosis and inflammation in HbeAg-negative chronic hepatitis B. BMC gastroenterology , 2005; 5:32 doi:10.1 186/1471-230×/5/32.
19. Plevris JN, Haydon GH, Simpson KJ, et al. Serum hualuronan-a non-invasive test for diagnosing liver cirrhosis. European journal of gastroenterology&hepatology, 2000, 12:1121-1127.
20. Desmet Murawaki Y, Iknta Y, Koda M, et al. Clinical significance of serum hyaluronan in patients with chronic viral liver disease. Journal of gastroenterology and hepatoloigy, 1996, 11: 459-465.
21. 中華肝臟病學會肝纖維化學組. 肝纖維化診斷及療效評估共識. 中華肝臟病雜志, 2002, 10(5): 327~328.
22. Lichtinghagen R, Bahr M. Noninvasive diagnosis of fibrosis in chronic liver disease . Expert. Rev. Mol. Diagn. 2004, 4(5): 715-726.
23. 權(quán)啟鎮(zhèn), 孫自勤, 王要軍. 主編. 新肝臟病學. 濟南: 山東科技出版社, 2003, 338.
24. Wang BE. 16 Kelleher TB, Mehta SH, Bhaskar R, et al. Prediction of hepatic fibrosis in HIV/HCV co-infected patients using serum fibrosis markers: the SHASTA index. Journal of hepatology, 2005, 43: 78-84.
25. Patel K, Gordon SC, Jacobson I, et al. Evaluation of a panel of non-invasive serum marders to differentiate mild from moderate-to-advanced liver fibrosis in chronic hepatitis C patients. Journal of hepatology, 2004, 41: 935-942.
26. Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study . Lancet, 2001, 357(9262): 1069-1075.
27. Forns X, Ampurdancs S, Llovet JM, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology, 2002, 36(4): 986-992.
28. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2): 518-526.
29. Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology, 1988, 95(3): 734-739.
30. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterolohy, 2005, 128: 343-350.
31. 羅建文, 邵金華, 白凈, 等. 瞬時彈性成像用于肝纖維化的無創(chuàng)評價. 中華肝臟病雜志, 2006, 14(5): 395~397.
32. Poynard T, Munteanu M, Imbert-Bismut F, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clinical chemistry, 2004, 50(8): 1344-1355.
33. Olga OZ, Nikolai DY. Invasive and non-invasive monitoring of hepatitis C virus-induced liver fibrosis: alternatives or complements? Current pharmaceutical biotechnology, 2003, 4: 195-209.
34. Afdhal NH, Evaluation of liver fibrosis: a concise review. American journal of gastroenterology, 2004, 1160-1174.
35. 年9月西安中華醫(yī)學會傳染病與寄生蟲病學分會、肝病學分會聯(lián)合修訂. 病毒性肝炎防治方案. 中華肝臟病雜志, 2000, 8(6): 324~329.
  1. 1. Wang BE, Zhang DF, editor-in-chief. Modern study of liver disease. 1rst edition. BeiJing: Science Press, 2003. p. 513.
  2. 2. Luo KX, editor in chief. Hepatitis B - basic and clinical. 1rst edition. BeiJing: People’s Health Press, 1997, p. 370.
  3. 3. Lang JM, editor in chief. Clinical Immunology diagnosis. 1rst edition. GuangZhou: Guangdong Science and Technology Press, 2003, p. 61.
  4. 4. Wang BE. Current trends in the study of liver fibrosis. Chinese magazine liver disease, 2006, 14(3): 167-168.
  5. 5. May 1995, the Fifth National Conference on parasitic diseases discuss infectious diseases. Viral hepatitis Control Program (Tentative) . Chinese Journal of Infectious Diseases, 1995, 13(4): 241-247.
  6. 6. Xian. the Chinese Medical Association in September 2000 credits infectious and parasitic diseases, liver diseases jointly amend credit. Viral hepatitis Control Program (Tentative). Chinese magazine liver disease, 2000, 8(6): 324-329.
  7. 7. Chinese chemical fiber liver Institute of liver disease. Clinical assessment and diagnosis of liver fibrosis consensus. Chinese magazine liver disease, 2002, 10(5): 327-328.
  8. 8. Quan QZ, Sun ZQ, Wang YJ, editor in chief. New Liver Diseases. JiLan: Shandong Science and Technology Press, 2003, 338.
  9. 9. Luo JW, Shao JH, Bai J, et al. Transient elastography imaging for the non-invasive evaluation of liver fibrosis. Chinese magazine liver disease, 2006, 14(5): 395-397.
  10. 10. 王寶恩, 張定鳳 主編. 現(xiàn)代肝臟病學. 第1版. 北京: 科學出版社, 2003, p. 513.
  11. 11. 駱抗先. 主編. 乙型肝炎－基礎(chǔ)和臨床. 第一版. 北京: 人民衛(wèi)生出版社, 1997, p. 370.
  12. 12. 朗江明. 主編. 臨床免疫診斷學. 第一版. 廣州: 廣東科技出版社, 2003, p. 61.
  13. 13. http://www.beixi.com/cn/the.htm.
  14. 14. 王寶恩. 當前肝纖維化研究的若干動向. 中華肝臟病雜志, 2006, 14(3): 167~168.
  15. 15. 1995年5月北京第五次全國傳染病寄生蟲病學術(shù)會議討論修訂. 病毒性肝炎防治方案（試行） . 中華傳染病雜志, 1995, 13(4): 241~247.
  16. 16. Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol, 1991, 13: 372.
  17. 17. Halfon P,Bourliere M, Penaranda G, et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus. Comparative hepatology, 2005, 4:6 dio: 10.1 186/1476-5926-4-6.
  18. 18. Montazeri G, Estakhri A, Mohamadnejad M, et al. Serum hyaluronate as a non-invasive marker of hepatic fibrosis and inflammation in HbeAg-negative chronic hepatitis B. BMC gastroenterology , 2005; 5:32 doi:10.1 186/1471-230×/5/32.
  19. 19. Plevris JN, Haydon GH, Simpson KJ, et al. Serum hualuronan-a non-invasive test for diagnosing liver cirrhosis. European journal of gastroenterology&hepatology, 2000, 12:1121-1127.
  20. 20. Desmet Murawaki Y, Iknta Y, Koda M, et al. Clinical significance of serum hyaluronan in patients with chronic viral liver disease. Journal of gastroenterology and hepatoloigy, 1996, 11: 459-465.
  21. 21. 中華肝臟病學會肝纖維化學組. 肝纖維化診斷及療效評估共識. 中華肝臟病雜志, 2002, 10(5): 327~328.
  22. 22. Lichtinghagen R, Bahr M. Noninvasive diagnosis of fibrosis in chronic liver disease . Expert. Rev. Mol. Diagn. 2004, 4(5): 715-726.
  23. 23. 權(quán)啟鎮(zhèn), 孫自勤, 王要軍. 主編. 新肝臟病學. 濟南: 山東科技出版社, 2003, 338.
  24. 24. Wang BE. 16 Kelleher TB, Mehta SH, Bhaskar R, et al. Prediction of hepatic fibrosis in HIV/HCV co-infected patients using serum fibrosis markers: the SHASTA index. Journal of hepatology, 2005, 43: 78-84.
  25. 25. Patel K, Gordon SC, Jacobson I, et al. Evaluation of a panel of non-invasive serum marders to differentiate mild from moderate-to-advanced liver fibrosis in chronic hepatitis C patients. Journal of hepatology, 2004, 41: 935-942.
  26. 26. Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study . Lancet, 2001, 357(9262): 1069-1075.
  27. 27. Forns X, Ampurdancs S, Llovet JM, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology, 2002, 36(4): 986-992.
  28. 28. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2): 518-526.
  29. 29. Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology, 1988, 95(3): 734-739.
  30. 30. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterolohy, 2005, 128: 343-350.
  31. 31. 羅建文, 邵金華, 白凈, 等. 瞬時彈性成像用于肝纖維化的無創(chuàng)評價. 中華肝臟病雜志, 2006, 14(5): 395~397.
  32. 32. Poynard T, Munteanu M, Imbert-Bismut F, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clinical chemistry, 2004, 50(8): 1344-1355.
  33. 33. Olga OZ, Nikolai DY. Invasive and non-invasive monitoring of hepatitis C virus-induced liver fibrosis: alternatives or complements? Current pharmaceutical biotechnology, 2003, 4: 195-209.
  34. 34. Afdhal NH, Evaluation of liver fibrosis: a concise review. American journal of gastroenterology, 2004, 1160-1174.
  35. 35. 年9月西安中華醫(yī)學會傳染病與寄生蟲病學分會、肝病學分會聯(lián)合修訂. 病毒性肝炎防治方案. 中華肝臟病雜志, 2000, 8(6): 324~329.