Leberspezifische Diagnostik bei der nichtalkoholischen Fettlebererkrankung (NAFLD) – wann kann die Leberbiopsie ersetzt werden?

Zusammenfassung

Die nichtalkoholische Fettlebererkrankung (NAFLD) ist eine der häufigsten Lebererkrankungen. In Deutschland wird die Prävalenz in der adulten Bevölkerung auf 24 % geschätzt, und die Inzidenz ist ansteigend. Prognostisch ist die Unterscheidung früher und fortgeschrittener Erkrankungsstadien von Bedeutung. Insbesondere das Ausmaß der Vernarbung, die als Leberfibrose bezeichnet wird, beeinflusst Morbidität und Mortalität von Patienten mit NAFLD. Bei Vorliegen einer fortgeschrittener Fibrose und Zirrhose steigen die leberspezifische und die Gesamtmortalität an. Die Leberfibrose entsteht als Konsequenz einer anhaltenden Entzündung des Lebergewebes über die Zeit. Da Entzündung und Fibrose histologische Merkmale der Erkrankung sind, gilt heute als Referenzmethode in der Diagnostik der NAFLD noch die Leberbiopsie. Zunehmend werden nichtinvasive diagnostische Verfahren zum Staging (der Fibrose) und Grading (Aktivität) der Erkrankung entwickelt und validiert. Die aktuelle Übersicht fasst neue Entwicklungen der nichtinvasiven Leberdiagnostik zusammen.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases. In Germany, the prevalence in the adult population is estimated at 24 % and the incidence is increasing. Prognostically, the distinction between early and advanced stages of the disease is important. In particular, the extent of scarring considered as liver fibrosis is of prognostic significance. Patients with advanced fibrosis and cirrhosis show increased mortality. Liver fibrosis develops as a consequence of a persistent inflammation of the liver tissue over time. Since inflammation and fibrosis are histological features, liver biopsy is considered the reference method in the diagnosis of NAFLD. More recently, non-invasive diagnostic methods for staging (of fibrosis) and grading (activity) of the disease are being developed and validated. The current review summarizes new developments in non-invasive liver diagnostics.

Schlüsselwörter

NAFLD - NASH - Fibrosemarker - Leberbiopsie - transiente Elastografie

Key words

NAFLD - NASH - fibrosis marker - liver biopsy - transient elastography

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