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Diagnostik der nichtalkoholischen Steatohepatitis

Histologie – Labor – Bildgebung

Diagnostics of nonalcoholic steatohepatitis

Histology, laboratory findings, imaging

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die nichtalkoholische Steatohepatitis (NASH) ist eine auf der ganzen Welt weit verbreitete Lebererkrankung. Vorhandensein und Ausmaß einer Leberverfettung können mittels nichtinvasiver Bildgebung, insbesondere Ultraschall und die Magnetresonanztomographie, relativ sicher vorhergesagt werden. Es fehlen zur Zeit allerdings reproduzierbare und nebenwirkungsarme nichtinvasive Testverfahren, die sicher zwischen einer reinen Steatose, einer Steatohepatitis oder einer Leberfibrose differenzieren können. Einen entscheidenden Fortschritt in der nichtinvasiven Diagnostik stellen möglicherweise Biomarker dar, die pathogenetische Faktoren umfassen. Hier werden momentan Marker der Entzündung, Apoptose, Fibrogenese oder des oxidativen Stress getestet. Vielversprechende neue Methoden unter Einbeziehung von Proteomics, Metabolomics und Genomics befinden sich noch im experimentellen Stadium. Die Leberbiopsie ist zur Zeit noch der Goldstandard zur Diagnose der NASH und zur definitiven Bestimmung des hepatischen Fibrosegrades.

Abstract

Nonalcoholic steatohepatitis (NASH) affects a substantial proportion of the population worldwide. Although the presence and amount of steatosis can be determined with a good level of accuracy using noninvasive imaging techniques, currently no noninvasive tests are available to distinguish between simple steatosis and steatohepatitis or to stage fibroses that are simple and reproducible. Current laboratory tests include biochemical analysis, but their utility for diagnosing NASH is still poor. For that reason, a great effort is being made to identify and validate novel biomarkers to assess NASH using high-throughput analysis based on genomics, proteomics, and metabolomics. At this time, liver biopsy remains the gold standard for diagnosing NASH.

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Danksagung

Prof. Peter J. Barth, Institut für Pathologie der Philipps-Universität Marburg, sei herzlich gedankt für die Überlassung der histologischen Abbildungen zur NASH.

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  1. Zentrum für Innere Medizin, Schwerpunkt Gastroenterologie, Justus-Liebig-Universität Gießen, Paul-Meimberg-Str. 5, 35385, Gießen, Deutschland

    E. Roeb

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Roeb, E. Diagnostik der nichtalkoholischen Steatohepatitis. Gastroenterologe 5, 108–115 (2010). https://doi.org/10.1007/s11377-009-0372-5

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