Der Internist

, Volume 51, Issue 1, pp 14–20 | Cite as

Leberfibrose

Klinik, Diagnostik und Management
Schwerpunkt

Zusammenfassung

Die Leberfibrose beschreibt eine chronische Schädigung der Leber durch die Vernarbung des Parenchyms. Sie tritt bei chronischen Lebererkrankungen auf und zeigt bei 20–40% der Patienten eine Progression zur Leberzirrhose. Die Klinik der Leberfibrose ist unspezifisch, sodass die Patienten häufig bei anderen Untersuchungen durch erhöhte Leberwerte identifiziert werden. Der Goldstandard zur Quantifizierung einer Leberfibrose ist die Leberbiopsie, jedoch stehen auch nicht-invasive Methoden zur Fibrosedetektion zur Verfügung. Hierzu zählen Serummarker und bildgebende Verfahren, wie die transiente Elastographie (Fibroscan®). Bei Nachweis einer Fibrose zielt die Therapie auf eine Stabilisierung der Leberschädigung oder im Idealfall auf deren Regression ab. Hierzu dienen in erster Linie ätiologie-abhängige Therapien der einzelnen Lebererkrankungen (z. B. antivirale Therapie bei Virushepatitis). Bei fehlendem Ansprechen besteht theoretisch die Möglichkeit einer unspezifischen (d. h. nicht an der Ätiologie der speziellen Erkrankung orientierten) Intervention. Diese Optionen basieren auf dem wachsenden pathophysiologischen Verständnis der Leberfibrosierung und werden in Zukunft an Bedeutung gewinnen.

Schlüsselwörter

Chronische Lebererkrankungen Leberfibrose Transiente Elastographie Antifibrotische Therapie Risikofaktoren 

Liver fibrosis

Clinics, diagnostics and management

Abstract

Liver fibrosis results from chronic liver damage and is characterized by scarring of the liver parenchyma. Liver fibrosis can occur in all chronic liver diseases and shows progression towards liver cirrhosis in 20–40% of cases. The clinical presentation of liver fibrosis is usually unspecific. Therefore, most patients with liver fibrosis are identified by elevated liver enzymes during other medical examinations. The gold standard for quantification of liver fibrosis is percutaneous liver biopsy, but non-invasive markers (e. g. serum markers, transient elastography) have recently been evaluated to identify individuals with significant fibrosis. In case of fibrosis detection, medical therapies aim at stabilizing liver scarring or even at inducing the regression of fibrosis. Primarily this is achieved by etiology specific therapies of chronic liver diseases (e. g. antiviral therapy, immunosuppressive therapy etc.). However, in cases of failure of these specific therapies, non-specific interventions for fibrosis regression are actively being investigated. These treatment options are based on the growing molecular knowledge of fibrogenesis but are not yet available for routine clinical use.

Keywords

Chronic liver diseases Liver fibrosis Transient elastography Antifibrotic therapies Risk factors 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Medizinische Klinik IIIUniversitätsklinikum Aachen, RWTH AachenAachenDeutschland

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