Beurteilung der Leberfibrose

Alle chronischen Leberschädigungen können zu einer pathologischen Regeneration führen – der Fibrose. Eine Leberfibrose entsteht ohne spezifische Symptome, was die frühzeitige Diagnose erschwert. Unerkannt und unbehandelt kann die Leberfibrose zur Leberzirrhose fortschreiten, die mit lebensgefährlichen Komplikationen wie Varizenblutungen einhergeht. Dieser Beitrag widmet sich der invasiven und nicht invasiven Diagnostik der Leberfibrose.

Schlüsselwörter

Leberzirrhose - transiente Elastografie - Scherwellenelastografie - Serummarker

• Literatur

• 1 Asrani SK, Devarbhavi H, Eaton J. et al. Burden of liver diseases in the world. J Hepatol 2019; 70: 151-171 doi:10.1016/j.jhep.2018.09.014
• 2 Pais R, Barritt ASt, Calmus Y. et al. NAFLD and liver transplantation: Current burden and expected challenges. J Hepatol 2016; 65: 1245-1257 doi:10.1016/j.jhep.2016.07.033
• 3 Wiegand J, Berg T. Ätiologie, Diagnose und Prävention einer Leberzirrhose. Dtsch Arztebl Int 2013; 110: 85-91 doi:10.3238/arztebl.2013.0085
• 4 Karkmann K, Piecha F, Runzi AC. et al. [Management of compensated liver cirrhosis 2018 – Evidence based prophylactic measures]. Z Gastroenterol 2018; 56: 55-69 doi:10.1055/s-0043-124000
• 5 Wiegard C, Schramm C, Lohse AW. Scoring systems for the diagnosis of autoimmune hepatitis: past, present, and future. Semin Liver Dis 2009; 29: 254-261 doi:10.1055/s-0029-1233532
• 6 European Association for the Study of the Liver, Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237-264 doi:10.1016/j.jhep.2015.04.006
• 7 Mueller S, Seitz HK, Schirmacher P. et al. Nicht invasive versus invasive Beurteilung der Leberfibrose. Gastroenterologie up2date 2014; 10: 51-67
• 8 Tannapfel A, Dienes HP, Lohse AW. Indikationen zur Leberbiopsie. Dtsch Arztebl Int 2012; 109: 477-483 doi:10.3238/arztebl.2012.0477
• 9 Regev A, Berho M, Jeffers LJ. et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97: 2614-2618 doi:10.1111/j.1572-0241.2002.06038.x
• 10 Parkes J, Guha IN, Roderick P. et al. Performance of serum marker panels for liver fibrosis in chronic hepatitis C. J Hepatol 2006; 44: 462-474 doi:10.1016/j.jhep.2005.10.019
• 11 Pfeifer L, Zopf S, Siebler J. et al. Prospective Evaluation of Acoustic Radiation Force Impulse (ARFI) Elastography and High-Frequency B-Mode Ultrasound in Compensated Patients for the Diagnosis of Liver Fibrosis/Cirrhosis in Comparison to Mini-Laparoscopic Biopsy. Ultraschall Med 2015; 36: 581-589 doi:10.1055/s-0041-107831
• 12 Friedrich-Rust M, Ong MF, Martens S. et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134: 960-974 doi:10.1053/j.gastro.2008.01.034
• 13 Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease. Hepat Med 2010; 2: 49-67
• 14 Castéra 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. Gastroenterology 2005; 128: 343-350
• 15 Marcellin P, Ziol M, Bedossa P. et al. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int 2009; 29: 242-247
• 16 Corpechot C, Carrat F, Poujol-Robert A. et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology 2012; 56: 198-208
• 17 Nahon P, Kettaneh A, Tengher-Barna I. et al. Assessment of liver fibrosis using transient elastography in patients with alcoholic liver disease. J Hepatol 2008; 49: 1062-1068
• 18 Gaia S, Carenzi S, Barilli AL. et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011; 54: 64-71
• 19 Lanzi A, Gianstefani A, Mirarchi MG. et al. Liver AL amyloidosis as a possible cause of high liver stiffness values. Eur J Gastroenterol Hepatol 2010; 22: 895-897 doi:10.1097/MEG.0b013e3283309d5b
• 20 Piecha F, Peccerella T, Bruckner T. et al. Arterial pressure suffices to increase liver stiffness. Am J Physiol Gastrointest Liver Physiol 2016; 311: G945-G953 doi:10.1152/ajpgi.00399.2015
• 21 Piecha F, Mandorfer M, Peccerella T. et al. Pharmacological decrease of liver stiffness is pressure-related and predicts long-term clinical outcome. Am J Physiol Gastrointest Liver Physiol 2018; 315: G484-G494 doi:10.1152/ajpgi.00392.2017
• 22 Piecha F, Paech D, Sollors J. et al. Rapid change of liver stiffness after variceal ligation and TIPS implantation. Am J Physiol Gastrointest Liver Physiol 2018; 314: G179-G187 doi:10.1152/ajpgi.00239.2017
• 23 Millonig G, Reimann FM, Friedrich S. et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology 2008; 48: 1718-1723 doi:10.1002/hep.22577
• 24 de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752 doi:10.1016/j.jhep.2015.05.022
• 25 Vizzutti F, Arena U, Romanelli RG. et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007; 45: 1290-1297 doi:10.1002/hep.21665
• 26 Jansen C, Moller P, Meyer C. et al. Increase in liver stiffness after transjugular intrahepatic portosystemic shunt is associated with inflammation and predicts mortality. Hepatology 2018; 67: 1472-1484 doi:10.1002/hep.29612