Can we treat hepatic fibrosis?

摘要

Small amounts of fibrous tissue are normally found in the healthy liver in the capsule, peri-vascular connective tissue and surrounding portal triads. Excessive fibrosis is a common, important, nonspecific, secondary response to hepatic injury. Several serum biomarkers of hepatic fibroplasia have been validated in human medicine, including hyaluronate, alpha-smooth muscle actin, AST:platelet ratio and the 'FibroTest' which combines serum haptoglobin, alpha 2 macroglobin, GGT, apolipoprotein A1, bilirubin, age and gender. Investigation of some of these variables has occurred in horses although none has achieved significant clinical use. In this author's experience serum globulin concentrations >50 g/l or bile acids >30 mmol/l found in horses with liver disease are almost invariably associated with significant hepatic fibrosis. Although there is evidence that ultrasonography can detect hepatic fibroplasia in horses (Durham etal. 2003a), veterinary surgeons are essentially reliant on biopsy or autopsy specimens to recognise fibrosis in horses' livers.