Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an important cause of chronic liver injury in many countries. The incidence of NAFLD is rising rapidly in both adults and children, because of the currently ongoing epidemics of obesity and type 2 diabetes. Notably, histological liver fibrosis is recognized as the main predictive factor for the overall long-term outcome of NAFLD, including cardiovascular disease and liver-related mortality. Thus, staging of liver fibrosis is essential in determining the prognosis and optimal treatment for patients with NAFLD and in guiding surveillance for the development of hepatocellular carcinoma (HCC). Whereas liver biopsy remains the gold standard for staging liver fibrosis, it is impossible to enforce liver biopsy in all patients with NAFLD. Noninvasive biological markers, scoring systems and noninvasive modalities are increasingly being developed and investigated to evaluate fibrosis stage of NAFLD patients. This review will highlight recent studies on the diagnosis and staging of NAFLD based on invasive (liver biopsy) or noninvasive (biomarker, scoring systems, US-based elastography and MR elastography) methods.

Clinical features of hepatocellular carcinoma in nonalcoholic fatty liver disease patients without advanced fibrosis

“…Systematic review have recommended liver stiffness by a Fibroscan of > 9 kPa as cutoff value of F3 in NAFLD. 23 Therefore, if the platelet count is < 19 × 104/mL or FIB4 index is > 2.67, advanced fibrosis is suspected. In these cases, liver stiffness should be measured by Fibroscan.…”

Protective Effects of Ipragliflozin, a Sodium-glucose Cotransporter 2 Inhibitor, on a Non-alcoholic Steatohepatitis Mouse Model

“…Among the situation that the number of patients with NASH has been increasing worldwide, several novel drugs are under clinical trials including an inhibitor of apoptosis signalregulating kinase-1 (ASK-1), a farnesoid X receptor (FXR) agonist and a fibroblast growth factor (FGF)-19 agonist. 1,2 Since there are no established treatments for NASH as of 2018, the application of novel drugs for NASH is long-awaited.…”

Serum soluble sialic acid‐binding immunoglobulin‐like lectin‐7 concentration as an indicator of liver macrophage activation and advanced fibrosis in patients with non‐alcoholic fatty liver disease

“…Several indicators of advanced fibrosis have been investigated in patients with NAFLD, including platelet counts, fibrosis score (fibrosis‐4 index [FIB‐4]), NAFLD fibrosis score, aspartate aminotransferase (AST)‐to‐platelet ratio index, gamma‐glutamyl transpeptidase‐to‐platelet ratio, and serum factors (type IV collagen, hyaluronic acid, Mac‐2 binding protein glycosylation isomer [M2BPGi]), ultrasound‐based elastography (virtual touch tissue quantification and transient elastography [TE]), and magnetic resonance elastography . In current clinical practice, combinations of several indicators, such as FIB‐4 or NAFLD fibrosis score plus TE, are used to stage fibrosis …”