Skip to main content
SpringerLink
Log in

Diagnostik: Algorithmus und Leberbiopsie

  • Chapter
  • First Online:
Nicht-alkoholische Fettlebererkrankung

  • 989 Accesses

Zusammenfassung

Etwa ein Viertel der Erwachsenen mit nicht-alkoholischer Fettlebererkrankung (NAFLD) zeigt eine nicht-alkoholische Steatohepatitis (NASH), die zu einer progressiven Leberfibrose und schließlich zu einer Zirrhose sowie auch zu einem hepatozellulären Karzinom führen kann. In den letzten 15 Jahren galt die Leberbiopsie als der Goldstandard der NAFLD-Diagnostik. In diesem Kapitel wird die Rolle nichtinvasiver Tests (serologische Marker, bildgebende Verfahren) bei der NAFLD-Bewertung analysiert, ausgehend von der geringen Adhärenz der Patienten für die hepatische Biopsie, möglichen Komplikationen und den damit verbundenen Kosten. Die Leberbiopsie bleibt die einzige Untersuchung, die zwischen einfacher Steatose und NASH unterscheiden kann. Die meisten NAFLD Patienten zeigen bioptisch nur eine Steatose (ohne Fibrose), die eine gute Prognose hat. Durch die Anwendung von Fibrosescores, Entzündungsmarkern im Serum und moderner Bildgebung in Kombination mit Elastografieverfahren wird die Leberbiopsie bei NAFLD nach und nach durch nicht invasive Verfahren ersetzt.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Akyuz U, Yesil A, Yilmaz Y (2015) Characterization of lean patients with nonalcoholic fatty liver disease: potential role of high hemoglobin levels. Scand J Gastroenterol. 50:341–346

    Article  CAS  Google Scholar 

  • Andronescu CI, Purcarea MR, Babes PA (2018) Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications. J Med Life 11:20–23

    PubMed  PubMed Central  Google Scholar 

  • Bedogni G, Bellentani S, Miglioli L et al (2006) The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 6:33

    Article  Google Scholar 

  • Brunt EM (2016) Nonalcoholic fatty liver disease: pros and cons of histologic systems of evaluation. Int J Mol Sci 17(1)

    Google Scholar 

  • Brunt EM, Janey CG, Di Bisceglie AM (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474

    Article  CAS  Google Scholar 

  • Canbay A, Feldstein A, Kronenberger B, Schulze-Osthoff K, Bantel H (2014) Cytokeratin 18 as marker for non-invasive diagnosis and prognosis of acute and chronic liver diseases. Z Gastroenterol. 52(3):290–295

    Article  CAS  Google Scholar 

  • Chan WK, Nik Mustapha NR, Mahadeva S (2014) Controlled attenuation parameter for the detection and quantification of hepatic steatosis in nonalcoholic fatty liver disease. J Gastroenterol Hepatol 29:1470–1476

    Article  CAS  Google Scholar 

  • Daniel S, Ben Menachem T, Vasudevan G, Blumenkehl M (1999) Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 94:3010–3014

    Article  CAS  Google Scholar 

  • de Alwis NM, Anstee QM, Day CP (2016) How to diagnose nonalcoholic fatty liver disease. Dig Dis 34(Suppl 1):19–26

    Article  Google Scholar 

  • Glen J, Floros L, Day C, Pryke R (2016) Non- alcoholic fatty liver disease (NAFLD): summary of NICE guidance. BMJ 354

    Google Scholar 

  • Gunn NT, Shiffmann ML (2018) The use of liver biopsy in nonalcoholic fatty liver disease: when to biopsy and in whom. Clin Liver Dis 22:109–119

    Article  Google Scholar 

  • Hamaguchi M, Kojima T, Itoh Y, Harano Y, Fujii K, Nakajima T, Kato T, Takeda N, Okuda J, Ida K, Kawahito Y, Yoshikawa T, Okanoue T (2007) The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol 102:2708–2715

    Article  Google Scholar 

  • Hamilton G, Middleton MS, Bydder M, Yokoo T, Schwimmer JB, Kono Y, Patton HM, Lavine JE, Sirlin CB (2009) Effect of PRESS and STEAM sequences on magnetic resonance spectroscopic liver fat quantification. J Magn Reson Imaging 30:145–152

    Article  Google Scholar 

  • Johnson NA, Walton DW, Sachinwalla T, Thompson CH, Smith K, Ruell PA, Stannard SR, George J (2008) Noninvasive assessment of hepatic lipid composition: advancing understanding and management of fatty liver disorders. Hepatology 47:1513–1523

    Article  CAS  Google Scholar 

  • Kleiner DE (2018) Histopathology, grading and staging of nonalcoholic fatty liver disease. Minerva Gastroenterol Dietol 64:28–38

    PubMed  Google Scholar 

  • Kwok R, Choi KC, Wong GL, Zhang Y, Chan HL, Luk AO, Shu SS, Chan AW, Yeung MW, Chan JC, Kong AP, Wong VW (2016) Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut 65(8):1359–1368

    Article  CAS  Google Scholar 

  • Larson SP, Bowers SP, Palekar NA, Ward JA, Pulcini JP, Harrison SA (2007) Histopathologic variability between the right and left lobes of the liver in morbidly obese patients undergoing Roux-en-Y bypass. Clin Gastroenterol Hepatol 5:1329–1332

    Article  Google Scholar 

  • Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Busuttil RW, Saab S, Lu DS (2004) Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology 230:276–280

    Article  Google Scholar 

  • Ludwig J, Viggiano TR, McGill DB, Oh BJ (1980) Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 55:434–438

    CAS  PubMed  Google Scholar 

  • Mandal A, Bhattarai B, Kafle P, Khalid M, Jonnadula SK, Lamicchane J, Kanth R, Gayam V (2018) Elevated liver enzymes in patients with Type 2 diabetes mellitus and non-alcoholic fatty liver disease. Cureus. 10(11):e3626

    PubMed  PubMed Central  Google Scholar 

  • Meisamy S, Hines CD, Hamilton G, Sirlin CB, McKenzie CA, Yu H, Brittain JH, Reeder SB (2011) Quantification of hepatic steatosis with T1-independent, T2- corrected MR imaging with spectral modeling of fat: blinded comparison with MR spectroscopy. Radiology 258:767–775

    Article  Google Scholar 

  • Naga Chalasani, Zobair Younossi, Joel E. Lavine, Michael Charlton, Kenneth Cusi, Mary Rinella, Stephen A. Harrison, Elizabeth M. Brunt, Arun J. Sanyal, (2018) The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 67 (1):328-357

    Google Scholar 

  • Nascimbeni F, Ballestri S, Machado MV, Mantovani A, Cortez-Pinto H, Targher G, Lonardo A (2018) Clinical relevance of liver histopathology and different histological classifications of NASH in adults. Expert Rev Gastroenterol Hepatol 12:351–367

    Article  CAS  Google Scholar 

  • Orlacchio A, Bolacchi F, Antonicoli M, Coco I, Costanzo E, Tosti D, Francioso S, Angelico M, Simonetti G (2012) Liver elasticity in NASH patients evaluated with real-time elastography (RTE) Ultrasound Med Biol 38:537–544

    Google Scholar 

  • Poynard T, Lassailly G, Diaz E, Clement K, Caïazzo R, Tordjman J, Munteanu M, Perazzo H, Demol B, Callafe R, Pattou F, Charlotte F, Bedossa P, Mathurin P, Ratziu V, FLIP consortium (2012a) Performance of biomarkers FibroTest, ActiTest, SteatoTest, and NashTest in patients with severe obesity: meta analysis of individual patient data. PLoS ONE 7(3):e30325

    Article  CAS  Google Scholar 

  • Poynard T, Lenaour G, Vaillant JC et al (2012b) Liver biopsy analysis has a low level of performance for diagnosis of intermediate stages of fibrosis. Clin Gastroenterol Hepatol 10:657–663

    Article  Google Scholar 

  • Raptis DA, Fischer MA, Graf R, Nanz D, Weber A, Moritz W, Tian Y, Oberkofler CE, Clavien PA (2012) MRI: the new reference standard in quantifying hepatic steatosis? Gut 61:117–127

    Article  Google Scholar 

  • Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, Grimaldi A, Capron F, Poynard T (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906

    Article  Google Scholar 

  • Roeb E, Steffen HM, Bantel H, Baumann U, Canbay A, Demir M, Drebber U, Geier A, Hampe J, Hellerbrand C, Pathil-Warth A, Schattenberg JM, Schramm C, Seitz HK, Stefan N, Tacke F, Tannapfel A, Lynen Jansen P, Bojunga J (2015) S2k Guideline non-alcoholic fatty liver disease. Z Gastroenterol 53:668–723

    Article  CAS  Google Scholar 

  • Roeb E, Steffen HM, Bojunga J (2016) Non-alcoholic fatty liver disease – what’s new. Dtsch Med Wochenschr 141:494–496

    Article  Google Scholar 

  • Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, Mullen KD, Cooper JN, Sheridan MJ (2002) The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123:745–750

    Article  Google Scholar 

  • Shi KQ, Tang JZ, Zhu XL, Ying L, Li DW, Gao J et al (2014) Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: a meta-analysis of diagnostic accuracy. J Gastroenterol Hepatol 29:1149–1158

    Article  Google Scholar 

  • Singh S, Muir AJ, Dieterich DT, Falck-Ytter YT (2017) American Gastroenterological Association Institute Technical Review on the role of elastography in chronic liver diseases. Gastroenterology 152(6):1544–1577

    Article  Google Scholar 

  • Skelly MM, James PD, Ryder SD (2001) Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 35:195–199

    Article  CAS  Google Scholar 

  • Sookoian S, Pirola CJ (2017) Systematic review with meta-analysis: risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Aliment Pharmacol Ther. 46:85–95

    Article  CAS  Google Scholar 

  • Sookoian S, Pirola CJ (2018) Systematic review with meta-analysis: the significance of histological disease severity in lean patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther 47:16–25

    Article  CAS  Google Scholar 

  • Sorbi D, Boynton J, Lindor KD (1999) The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol 94:1018–1022

    Article  CAS  Google Scholar 

  • Tannapfel A, Denk H, Dienes HP, Langner C, Schirmacher P, Trauner M, Flott-Rahmel B (2011) Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease. Virchows Arch. 458(5):511–523

    Article  CAS  Google Scholar 

  • Tannapfel A, Dienes HP, Lohse AW (2012) The indications for liver biopsy. Dtsch Arztebl Int 109(27–28):477–483

    PubMed  PubMed Central  Google Scholar 

  • Tapper EB, Krajewski K, Lai M, Challies T, Kane R, Afdhal N, Lau D (2014) Simple non-invasive biomarkers of advanced fibrosis in the evaluation of non-alcoholic fatty liver disease. Gastroenterol Rep (oxf) 2:276–280

    Article  Google Scholar 

  • Targher G, Byrne CD (2016) Obesity: metabolically healthy obesity and 1310 NAFLD. Nat Rev Gastroenterol Hepatol. 13:442–444

    Article  Google Scholar 

  • Wei JL, Leung JC, Loong TC et al (2015) Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using proton-magnetic resonance spectroscopy. Am J Gastroenterol. 110:1306–1314

    Article  CAS  Google Scholar 

  • Weiß J, Rau M, Geier A (2014) Non-alcoholic fatty liver disease: epidemiology, clinical course, investigation, and treatment. Dtsch Arztebl Int. 111:447–452

    PubMed  PubMed Central  Google Scholar 

  • Yoneda M, Suzuki K, Kato S, Fujita K, Nozaki Y, Hosono K, Saito S, Nakajima A (2010) Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 256:640–647

    Article  Google Scholar 

  • Ying Qu, Yan-Yan Song, Cheng-Wei Chen, Qing-Chun Fu, Jun-Ping Shi, Yun Xu, Qing Xie, Yong-Feng Yang, Yong-Jian Zhou, Liang-Ping Li, Ming-Yi Xu, Xiao-Bo Cai, Qi-Di Zhang, Hao Yu, Jian-Gao Fan, Lun-Gen Lu, (2021) Diagnostic Performance of FibroTouch Ultrasound Attenuation Parameter and Liver Stiffness Measurement in Assessing Hepatic Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Clinical and Translational Gastroenterology 12 (4):e00323

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik UKGM, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    Elke Roeb

Authors
  1. Elke Roeb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elke Roeb .

Editor information

Editors and Affiliations

  1. Medizinische Klinik u. Poliklinik II, Universititätsklinikum Würzburg, ZIM, Würzburg, Bayern, Deutschland

    Andreas Geier

  2. Medizinische Klinik, Universitätsklinikum Bochum GmbH, Bochum, Deutschland

    Ali Canbay

  3. Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg, Saarland, Deutschland

    Frank Lammert

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Roeb, E. (2022). Diagnostik: Algorithmus und Leberbiopsie. In: Geier, A., Canbay, A., Lammert, F. (eds) Nicht-alkoholische Fettlebererkrankung. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62484-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-62484-5_16

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-62483-8

  • Online ISBN: 978-3-662-62484-5

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation