Non-invasive markers of liver injury

摘要

The severity of viral hepatitis is related to the progression of fibrosis towards cirrhosis and its complications. Data regarding liver histology are considered essential for treatment decisions and for the follow-up of patients with hepatitis C virus (HCV) infection. Until now liver histology could be assessed only by liver biopsy, usually done via the intercostal route. However, the numerous limitations of liver biopsy do not make it a simple procedure, or suitable on a large scale. Liver biopsy is not risk-free and can be experienced by patients as an aggressive procedure, therefore becoming a potential obstacle to the effective management of hepatitis C. Studies of biopsy complications show that pain is reported by one-third of patients, a severe complication (which is life-threatening or prolongs hospitalization) occurs in three out of 1000 cases and death in three out of 10 000 cases. A regional survey of 1177 general practitioners performed in Auvergne, France, revealed that liver biopsy was refused by 59% of HCV patients and that 22% of physicians were reluctant to recommend this procedure to their patients. That could probably partially explain why less than 50000 patients have been treated so far among the 600 000 HCV-infected patients in France. Moreover, the high sampling variability makes biopsy an indirect marker of liver injury, the true 'gold standard' being the liver in its entirety.