肝硬化人群筛查。

IF 5.6 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Communications Pub Date : 2024-08-26 eCollection Date: 2024-09-01 DOI:10.1097/HC9.0000000000000512
Maja Thiele, Elisa Pose, Adrià Juanola, Jessica Mellinger, Pere Ginès
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引用次数: 0

摘要

为了应对与肝脏相关的发病率和死亡率这一日益严重的健康危机,肝硬化筛查已成为一种早期发现和及时干预的有效策略。通过识别严重肝纤维化或代偿期肝硬化患者,筛查有望提高治疗效果,延缓疾病进展,并最终改善患者的生活质量。目前,国际科学协会的临床实践指南建议采取有针对性的筛查策略,对具有已知肝病风险因素的高危人群进行调查。虽然有充分证据表明筛查能增加人群中的病例发现率,而且越来越多的研究表明筛查能促使脂肪肝患者改变有益的生活方式,但在实施肝硬化筛查计划之前,仍有许多知识空白需要澄清。首先,需要进行随机试验,以确保筛查能改善与肝脏相关的发病率和死亡率。否则,肝硬化筛查可能会因过度诊断、过度治疗、医疗成本增加、筛查带来的负面心理影响以及徒劳的侵入性检查而违背伦理。此外,用于筛查的检测方法需要优化,以降低假阳性率,而不是目前使用的 FIB-4,同时保留极少的假阴性率。最后,还需要阐明坚持筛查和实施筛查计划的障碍。本综述全面概述了肝硬化筛查策略的现状,以及目前早期肝硬化检测方法的前景和缺陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Population screening for cirrhosis.

In response to the growing health crisis of liver-related morbidity and mortality, screening for liver cirrhosis has emerged as a promising strategy for early detection and timely intervention. By identifying individuals with severe fibrosis or compensated cirrhosis, screening holds the promise of enhancing treatment outcomes, delaying disease progression, and ultimately improving the quality of life of affected individuals. Clinical practice guidelines from international scientific societies currently recommend targeted screening strategies, investigating high-risk populations with known risk factors of liver disease. While there is good evidence that screening increases case finding in the population, and a growing number of studies indicate that screening may motivate beneficial lifestyle changes in patients with steatotic liver disease, there are major gaps in knowledge in need of clarification before screening programs of cirrhosis are implemented. Foremost, randomized trials are needed to ensure that screening leads to improved liver-related morbidity and mortality. If not, screening for cirrhosis could be unethical due to overdiagnosis, overtreatment, increased health care costs, negative psychological consequences of screening, and futile invasive investigations. Moreover, the tests used for screening need to be optimized toward lower false positive rates than the currently used FIB-4 while retaining few false negatives. Finally, barriers to adherence to screening and implementation of screening programs need to be elucidated. This review provides a comprehensive overview of the current landscape of screening strategies for liver cirrhosis and the promises and pitfalls of current methods for early cirrhosis detection.

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来源期刊
Hepatology Communications
Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
8.00
自引率
2.00%
发文量
248
审稿时长
8 weeks
期刊介绍: Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction. ​
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