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| 1 | Biomarkers in nonalcoholic fatty liver disease-the emperor has no clothes?显示文摘Fatty liver is present in over ten percentage of the world population and it is a growing public health problem.Nonalcoholic fatty liver disease(NAFLD) is not a single disease,but encompasses a spectrum of diseases of different etiologies.It is difficult to find highly specific and sensitive diagnostic biomarkers when a disease is very complex.Therefore,we should aim to find relevant prognostic markers rather than accurate diagnostic markers which will help to minimize the frequency of liver biopsies to evaluate disease progression.There are several biomarker panels commercially available,however,there is no clear evidence that more sophisticated panels are better compared to simple criteria such as,presence of diabetes over five years,metabolic syndrome,obesity,obstructive sleep apnea,aspartate transaminase/alanine transaminase(ALT) ratio > 0.8 or ferritin levels > 1.5 times normal in patients with over six month history of raised ALT and/or ultrasonological evidence of fat in the liver.Currently the biomarker panels are not a replacement for a liver biopsy.However the need and benefit of liver biopsy in NAFLD is questionable because there is no convincing evidence that biopsy and detailed staging of NAFLD improves the management of NAFLD and benefits the patient.After all there is no evidence based treatment for NAFLD other than management of lifestyle and components of 'metabolic syndrome'. | Madhusudana Girija Sanal | 2015 | World Journal of Gastroenterology2015，21，11： | 4 |
| 2 | Diagnostic accuracy of enhanced liver fibrosis test to assess liver fibrosis in patients with chronic hepatitis C显示文摘BACKGROUND:The prognosis and clinical management of patients with chronic liver diseases are closely related to the severity of liver fibrosis.Liver biopsy is considered the gold standard for the staging of liver fibrosis.However,it is an invasive test sometimes related to complications.This study aimed to assess the diagnostic value of enhanced liver fibrosis(ELF) test to predict liver fibrosis in patients with chronic hepatitis C.METHODS:This study included 162 patients with liver disease and 67 healthy controls.Hyaluronic acid,tissue inhibitor of matrix metalloproteinase type 1,and amino-terminal propeptide type III procollagen were measured by enzymelinked immunosorbent assay with the ELF test ADVIA Centaur(Siemens Healthcare Diagnostics Inc.).Fibrosis stage was determined using the Metavir scoring system.RESULTS:In our study,for the diagnosis of significant fibrosis(Metavir F≥2) a cut-off value >7.72 provides a sensitivity of 93.0% and a specificity of 83.0%.The areas under the receiver operator characteristic curve,sensitivity,specificity,and positive and negative predictive values were 0.94,93.3%,81.0%,93.3%,and 81.0%,respectively(P<0.001).For the diagnosis of cirrhosis(Metavir F=4) a cut-off value >9.3 provides a sensitivity of 93.0% and a specificity of 86.0%.The areas under the receiver operator characteristic curve,sensitivity,specificity,and positive and negative predictive values were 0.94,79.1%,90.8%,75.6%,and 92.3%,respectively(P<0.001).CONCLUSIONS:The ELF test is a promising non-invasive method for assessing liver fibrosis in patients with chronic hepatitis C.It is effective in the diagnosis of both fibrosis and cirrhosis. | Roberto Catanzaro Michele Milazzo Silvia Arona Chiara Sapienza Dario Vasta Domenico Arcoria Francesco Marotta | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，5： | 3 |
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