肝硬化相关门静脉高压无创检测的研究进展

摘要/Abstract

摘要： 门静脉高压是肝硬化患者最常见也是最主要的并发症,其导致的食管胃底静脉曲张破裂出血是肝硬化患者最主要的死亡原因之一。肝静脉压力梯度(HVPG)是评价门静脉高压及其严重程度最准确的方法,胃镜检查是筛查和评估食管胃静脉曲张及其严重程度的金标准,但两项检查均为侵入性操作,限制了其临床适用性。CT、MR、弹性成像技术及新兴的无创检测方法被越来越广泛地应用于门静脉高压、食管胃底静脉曲张的诊断及分层,但能够媲美HVPG和胃镜检查的无创检测方法仍需进一步探索。

关键词: 肝硬化, 门静脉高压, 食管胃底静脉曲张, 无创检测

符艳, 王晓忠. 肝硬化相关门静脉高压无创检测的研究进展[J]. 肝脏, 2023, 28(10): 1234-1237.

参考文献

[1] Mnif L, Hachicha S, Abid F, et al. Role of splenic and hepatic stiffness in predicting esophageal varices. Tunis Med, 2021, 99(5): 544-551.
[2] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 2017, 65(1): 310-335.
[3] Bochnakova T. Hepatic venous pressure gradient. Clin Liver Dis (Hoboken), 2021, 17(3): 144-148.
[4] De Franchis R. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3): 743-752.
[5] De Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension. J Hepatol, 2022, 76(4): 959-974.
[6] Mendoza Y, Cocciolillo S, Murgia G, et al. Noninvasive markers of portal hypertension detect decompensation in overweight or obese patients with compensated advanced chronic liver disease. Clin Gastroenterol Hepatol, 2020, 18(13): 3017-3025.e6.
[7] Stafylidou M, Paschos P, Katsoula A, et al. Performance of Baveno VI and expanded Baveno VI criteria for excluding high-risk varices in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2019, 17(9): 1744-1755.e11.
[8] Lee H A, Kim SU, Seo YS, et al. Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease. Liver Int, 2019, 39(6): 1071-1079.
[9] Galizzi HO, Couto CA, Taranto DOL, et al. Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease. Ann Hepatol, 2021, 20: 100229.
[10] Manatsathit W, Samant H, Kapur S, et al. Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: systemic review and meta-analysis. J Gastroenterol Hepatol, 2018, 33(10): 1696-1706.
[11] Buechter M, Manka P, Theysohn JM, et al. Spleen stiffness is positively correlated with HVPG and decreases significantly after TIPS implantation. Dig Liver Dis, 2018, 50(1): 54-60.
[12] Stefanescu H, Rusu C, Lupsor-Platon M, et al. Liver stiffness assessed by ultrasound shear wave elastography from general electric accurately predicts clinically significant portal hypertension in patients with advanced chronic liver disease. Ultraschall Med, 2020, 41(5): 526-533.
[13] Janik MK, Kruk B, Szczepankiewicz B, et al. Measurement of liver and spleen stiffness as complementary methods for assessment of liver fibrosis in autoimmune hepatitis. Liver Int, 2021, 41(2): 348-356.
[14] Song J, Huang J, Huang H, et al. Performance of spleen stiffness measurement in prediction of clinical significant portal hypertension: a meta-analysis. Clin Res Hepatol Gastroenterol, 2018, 42(3): 216-226.
[15] Tseng Y, Li F, Wang J, et al. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices. J Clin Ultrasound, 2018, 46(7): 442-449.
[16] Stefanescu H, Marasco G, Calès P, et al. A novel spleen-dedicated stiffness measurement by FibroScan? improves the screening of high-risk oesophageal varices. Liver Int, 2020, 40(1): 175-185.
[17] Ma X, Wang L, Wu H, et al. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS One, 2016, 11(11): e0165786.
[18] Colecchia A, Ravaioli F, Marasco G, et al. A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease. J Hepatol, 2018, 69(2): 308-317.
[19] Wang H, Wen B, Chang X, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol, 2021, 74(3): 584-592.
[20] Ozturk A, Grajo J R, Dhyani M, et al. Principles of ultrasound elastography. Abdom Radiol (NY), 2018, 43(4): 773-785.
[21] Matsui T, Nagai H, Watanabe G, et al. Usefulness of virtual touch tissue quantification for predicting the presence of esophageal varices in patients with liver cirrhosis. JGH Open, 2021, 5(6): 695-704.
[22] Attia D, Schoenemeier B, Rodt T, et al. Evaluation of liver and spleen stiffness with acoustic radiation force impulse quantification elastography for diagnosing clinically significant portal hypertension. Ultraschall Med, 2015, 36(6): 603-610.
[23] Vuille-Lessard É, Rodrigues SG, Berzigotti A. Noninvasive detection of clinically significant portal hypertension in compensated advanced chronic liver disease. Clin Liver Dis, 2021, 25(2): 253-289.
[24] 张智林, 周惠惠, 张君, 等. 二维剪切波弹性成像技术鉴别特发性门静脉高压与肝硬化门静脉高压的价值. 中国超声医学杂志, 2021, 37(09): 1017-1021.
[25] Zhu YL, Ding H, Fu TT, et al. Portal hypertension in hepatitis B-related cirrhosis: diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography. Hepatol Res, 2019, 49(5): 540-549.
[26] Trebicka J, Gu W, De Ledinghen V, et al. Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease. Gut, 2022, 71(2): 402-414.
[27] Xu SH, Wu F, Guo LH, et al. Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis. World J Gastroenterol, 2020, 26(45): 7204-7221.
[28] Maruyama H, Yokosuka O. Ultrasonography for noninvasive assessment of portal hypertension. Gut Liver, 2017, 11(4): 464-473.
[29] Li Y, Li L, Weng HL, et al. Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients: a systematic review and meta-analysis. World J Gastroenterol, 2020, 26(18): 2247-2267.
[30] Hammer S, Zeman F, Schlitt HJ, et al. Comparison of sequential CT arterioportography-arteriosplenography with standard cross-sectional imaging and endoscopy in children with portal hypertension. Sci Rep, 2022, 12(1): 6554.
[31] Catucci D, Obmann V C, Berzigotti A, et al. Noninvasive assessment of clinically significant portal hypertension using ΔT1 of the liver and spleen and ECV of the spleen on routine Gd-EOB-DTPA liver MRI. Eur J Radiol, 2021, 144: 109958.
[32] Jhang ZE, Wu KL, Chen CB, et al. Diagnostic value of spleen stiffness by magnetic resonance elastography for prediction of esophageal varices in cirrhotic patients. Abdom Radiol (NY), 2021, 46(2): 526-533.
[33] Gupta I, Eisenbrey JR, Machado P, et al. Diagnosing portal hypertension with noninvasive subharmonic pressure estimates from a US contrast agent. radiology, 2021, 298(1): 104-111.
[34] Simbrunner B, Marculescu R, Scheiner B, et al. Non-invasive detection of portal hypertension by enhanced liver fibrosis score in patients with different aetiologies of advanced chronic liver disease. Liver Int, 2020, 40(7): 1713-1724.
[35] Sandahl TD, Mcgrail R, Møller HJ, et al. The macrophage activation marker sCD163 combined with markers of the enhanced liver fibrosis (ELF) score predicts clinically significant portal hypertension in patients with cirrhosis. Aliment Pharmacol Ther, 2016, 43(11): 1222-1231.
[36] Berzigotti A, Seijo S, Arena U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology, 2013, 144(1): 102-111.e1.
[37] Kobayashi K, Uldry E, Kokudo T, et al. Correlation between portal pressure and indocyanine green retention rate is unaffected by the cause of cirrhosis: a prospective study. World J Surg, 2021, 45(8): 2546-2555.
[38] Bruha R, Jachymova M, Petrtyl J, et al. Osteopontin: a non-invasive parameter of portal hypertension and prognostic marker of cirrhosis. World J Gastroenterol, 2016, 22(12): 3441-3450.
[39] Hametner S, Ferlitsch A, Ferlitsch M, et al. The VITRO score (von willebrand factor antigen/thrombocyte ratio) as a new marker for clinically significant portal hypertension in comparison to other non-invasive parameters of fibrosis including ELF test. PLoS One, 2016, 11(2): e0149230.
[40] EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol, 2021, 75(3): 659-689.
[41] Wang S, Huang Y, Hu W, et al. Detachable string magnetically controlled capsule endoscopy for detecting high-risk varices in compensated advanced chronic liver disease (CHESS1801): a prospective multicenter study. Lancet Reg Health West Pac, 2021, 6: 100072.
[42] Zhang S, Song W, Yang B, et al. A non-invasive model based on the virtual portal pressure gradient to predict the first variceal hemorrhage in cirrhotic patients. Hepatol Int, 2022, 16(4): 926-935.
[43] Liu H, Sun J, Liu X, et al. Dual-energy computed tomography for non-invasive prediction of the risk of oesophageal variceal bleeding with hepatitis B cirrhosis. Abdom Radiol (NY), 2021, 46(11): 5190-5200.
[44] Yan Y, Li Y, Fan C, et al. A novel machine learning-based radiomic model for diagnosing high bleeding risk esophageal varices in cirrhotic patients. Hepatol Int, 2022, 16(2): 423-432.