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Romanian Journal of Internal Medicine

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Liver Fibrosis: Causes and Methods of Assessment, A Review

Ali Erfani Karimzadeh Toosi
  • Corresponding author
  • Shahid Beheshti University Hospital, Guilan University of Medical Sciences, Gilan, Iran
  • Email:
Published Online: 2015-12-10 | DOI: https://doi.org/10.1515/rjim-2015-0039

Abstract

Hepatic fibrogenesis is the final result of injury to the liver. Fibrosis could lead to hepatic dysfunction, important in the pathogenesis of other chronic problems. Therefore, understanding the mechanism, accurate diagnosis and staging of it in early stages accelerates the treatment and reduces the prevalence of chirrosis. Treatment strategies of liver problems and detction methods depend on the amount and progression of liver fibrosis and the rate of cirrhosis development. Traditionally the invasive method, liver biopsy, is reference standard to follow progression and stage of fibrosis. However, during the past decade, progressive development of novel non-invasive methodologies has challenged the invasive method. Non-invasive methods have been initially introduced for chronic hepatitis C with increasing use in other chronic liver diseases. The need for liver biopsy has nowadays decreased significantly as a result of these methodologies. Most of the new non-invasive methods depend on either ‘biological’ or ‘physical’ approaches.

In this review, starting from the mechanism of fibrogenesis, the current knowledge about diagnosis, treatment strategies and different methods for its evaluation is discussed. This is followed by a conclusion on what is expected to be known in this field during the future research.

Fibrogeneza hepatică este rezultatul final al leziunii hepatice. Fibroza duce la disfuncţie hepatică ce determină alte comorbidităţi. Înţelegerea aşadar a mecanismelor fibrogenetice, realizarea unui diagnostic corect încă din stadiile timpurii duce la scăderea prevalenţei cirozei hepatice. Strategiile terapeutice şi metodele de detecţie depind de progresia fibrozei hepatice şi de rata dezvoltării cirozei. Tradiţional, standardul de aur pentru evaluarea cirozei hepatice este puncţia, biopsia hepatică, o manvera invazivă. În ultimul timp însă au fost dezvoltate mai multe metode non-invazive pentru a putea evalua mai uşor fibroza hepatică. Iniţial aceste metode au fost dezvoltate pentru pacienţii cu hepatită cronică cu virus hepatitic C. Astfel că necesitatea biopsiei a scăzut foarte mult în ultima vreme.

În acest articol tip review sunt trecute în revistă principalele mecanisme fibrogenetice, diagnosticul fibrozei hepatice, strategiile pentru evaluarea şi tratamentul fibrozei hepatice.

Keywords: Liver biopsy; FibroScan®; Fibrosis; Fibrosis mechanism; Fibrotest

ABBREVIATIONS

AE2

Anion exchanger 2

AIP

Autoimmune pancreatitis

ALP

Alkaline phosphatase

ALT

Alanine aminotransferase;

AMAs

Antimitochondrial antibodies

ANIT

Alpha-naphthylisothiocyanate

APRI

Aspartate-to-Platelet Ratio Index

ARFI

Acoustic Radiation Force Impulse

AST

Aspartate AminoTransferase

AST/ALT

Aspartate aminotransferase/alanine aminotransferase ratio index

AUROC

Area under the receiver operating characteristic curve

BMI

Body mass index

CAP

Controlled attenuation parameter

CFTR

Cystic fibrosis transmembrane conductance regulator

CHB

Chronic hepatitis B

CHC

Chronic hepatitis C

CI

Confidence interval

CLDs

Chronic liver diseases

CRBP

Cellular retinol-binding proteins

CRC

Colorectal cancer

CTGF

Connective tissue growth factor

DCC

3.5-diethoxycarbonyl-1.4-dihydrocollidine

ECM

Extracellular matrix

EMT

Epithelial-mesenchymal transition

ERCP

Endoscopic retrograde cholangio-pancreaticography

ETM

Epithelial-mesenchymal transition

FGF-2

Fibroblast growth factor-2

FLI

Fatty liver index

FT

FibroTest®

G1

Genotype 1

GFAP

Glial fibrillary acidic protein

GGT

Gamma-Glutamyl Transpeptidase

Gnt-V

N-acetyl glucosaminyltransferase V

HBV

Hepatitis B virus

HCC

Hepatocellular carcinomas

HCV

Hepatitis C virus

HD

Hemodialysis

HGF

Hepatocyte growth factor

HSC

Hepatic stellate cells

IGF1

Insulin-like growth factor 1

ILK

Integrin-linked kinase

IQR

Interquartile range

KO

Knockout

kPa

Kilopascal

KS

King’s score

LB

Liver biopsy

LRAT

Lecithin-retinol acyltransferase

LSM

Liver Stiffness Measurement

LXR

Liver X receptor

MCP-1

Monocyte chemoattractant protein-1

MFs

Myofibroblasts

MRCP

Magnetic resonance cholangio-pancreaticography

NAFLD

Nonalcoholic fatty liver disease

NASH

Nonalcoholic steatohepatitis

NGF

Nerve growth factor

NPV

Negative predictive value

OR

Odds ratio

pANCA

Perinuclear antineutrophil cytoplasmatic antibody

PBC

Primary biliary cirrhosis

PDC-E2

E2 subunit of pyruvate dehydrogenase complex

PDGF

Platelet-derived growth factor

PPARγ

Peroxisome proliferator activated receptor γ

PPV

Positive predictive value;

PSC

Primary sclerosing cholangitis

PT

Prothrombin time

RI

Ribonuclease inhibitor

ROI

Region of interest

SF

Significant fibrosis

SSI

Supersonic shear imaging

STAP

Stellate cell activation-associated protein

TE

Transient elastography

TGFβ

Transforming growth factor β

UDCA

Ursodeoxycholic acid

US

Ultrasonography

VCTE

Vibration-controlled transient elastography

VDR

Farnesoid X receptor (FXR), vitamin D receptor

VEGF

Vascular endothelial growth factor

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About the article

Received: 2015-05-05

Published Online: 2015-12-10

Published in Print: 2015-12-01


Citation Information: Romanian Journal Of Internal Medicine, ISSN (Online) 1220-4749, DOI: https://doi.org/10.1515/rjim-2015-0039. Export Citation

© 2015 Ali Erfani Karimzadeh Toosi, published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)

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