无症状肝病患者:发现早期门脉高压和常规数据和肝脏硬度

StephenW

Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: A prospective study

    Salvador Augustin 1, Corresponding author contact information, E-mail the corresponding author,
    Laura Millán 1,
    Antonio González 1,
    María Martell 1,
    Arántzazu Gelabert 2,
    Antoni Segarra 2,
    Xavier Serres3,
    Rafael Esteban 1, 4,
    Joan Genescà 1, 4



        http://dx.doi.org/10.1016/j.jhep.2013.10.027
  
Background & Aims

Detecting portal hypertension (PH) before the development of varices is important for prognosis and for designing interventional studies. None of the available strategies is used in practice. We evaluated a sequential screening-diagnostic strategy based on clinical data and transient elastography (TE) to detect PH in asymptomatic outpatients with liver disease.
Methods

Consecutive patients with chronic liver disease and no previous diagnosis of PH were screened by TE. Patients with liver stiffness (LS) ⩾13.6 kPa were further evaluated by endoscopy and hepatic venous pressure gradient (HVPG). For analysis, patients were classified in 3 groups: group A, platelets ⩾150,000/mm3, normal abdominal ultrasound; group B, platelets <150,000/mm3, normal ultrasound; group C, platelets <150,000/mm3, abnormal ultrasound (splenomegaly, nodular liver surface).
Results

250 patients were evaluated (69% group A, 20% group B, 11% group C). In 9% elastography was non-valid. LS ⩾13.6 was found in 54 patients (8% A, 43% B, and 81% C, p <0.001). Endoscopy was performed in 49 of these: 20% had small varices, 0% high-risk varices. No patients from group A had varices, and 90% with varices belonged to group C. HVPG was obtained in 40 patients: 93% had PH (HVPG >5 mmHg) and 65% clinically significant PH (CSPH, HVPG ⩾10). Only 3 patients, all from group A, had HVPG <5. All patients from groups B and C with LS ⩾13.6 had PH. The LS 25 cut-off was excellent at ruling-in CSPH.
Conclusions

A simple strategy based on routine clinical data and TE could be useful to detect early PH among asymptomatic patients with chronic liver disease.
Abbreviations

    HVPG, hepatic venous pressure gradient;
    CSPH, clinically significant portal hypertension;
    TE, transient elastography;
    US, ultrasonography;
    LS, liver stiffness;
    LSPS, liver stiffness*spleen diameter/platelet ratio;
    VRS, Variceal Risk Score;
    PHRS, Portal Hypertension Risk Score;
    INR, international normalized ratio;
    BMI, body mass index

Keywords

    Transient elastography;
    HVPG;
    Liver disease;
    Esophageal varices;
    Compensated cirrhosis;
    Non-invasive diagnosis

Corresponding author contact information
    Corresponding author. Address: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Passeig Vall d’Hebron 119, 08035 Barcelona, Spain. Tel.: +34 93 274 6140.

Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier Ireland Ltd. All rights reserved.

StephenW

发现早期门脉高压的常规数据和肝脏硬度的患者无症状肝病患者：一项前瞻性研究

    萨尔瓦多奥古斯丁1 ，通讯作者的联系信息，电子邮件通讯作者，
    劳拉文澜1 ，
    安东尼奥·冈萨雷斯1 ，
    玛丽亚·马爹利1 ，
    Arantzazu酒店GELABERT 2 ，
    安东尼SEGARRA 2 ，
    泽维尔Serres3 ，
    拉斐尔·埃斯特万1 ， 4 ，
    琼Genescà 1 ， 4



        http://dx.doi.org/10.1016/j.jhep.2013.10.027
  
背景及宗旨

静脉曲张的发展前检测门静脉高压（PH ）是重要的预后和设计干预研究。没有可用的策略被用于实践。我们评估了基于临床数据和瞬时弹性成像（TE）来检测PH值在无症状门诊肝病顺序筛查诊断策略。
方法

连续治疗慢性肝病和PH值没有以前的诊断是由TE的筛选。患者的肝脏硬度（ LS ） ⩾ 13.6千帕经胃镜和肝静脉压力梯度（HVPG ）进行进一步评估。为了便于分析，患者被分为3组：A组，血小板⩾ 150,000个/ mm3 ，正常腹部超声，B组，血小板< 150,000 / mm3时，正常的超声检查，C组，血小板< 150,000 / mm3时，异常超音波（脾大，结节肝表面） 。
结果

250例患者进行了评估（ 69 ％ A组， 20 ％ ，B组11 ％ ，C组） 。在9 ％弹性是非有效的。 LS ⩾ 13.6中发现54例（ 8 ％ A， 43 ％B ， 81％ C，P < 0.001 ） 。在这49进行内窥镜检查： 20 ％有小的静脉曲张， 0 ％，高风险的静脉曲张。从A组无一例患者有静脉曲张， 90 ％与静脉曲张属于C组HVPG在40例患者获得： 93 ％的人PH值（ HVPG > 5毫米汞柱）和65 ％临床上显著PH值（ CSPH ， HVPG ⩾ 10 ） 。仅3例，全部来自A组，有HVPG < 5 。所有患者在B，C组与LS ⩾ 13.6有PH值。对LS 25截止是优秀的执政党，在CSPH 。
结论

根据常规的临床数据和TE一个简单的策略可能是有用的检测中无症状患者慢性肝病的早期PH值。
缩略语

    HVPG ，肝静脉压力梯度;
    CSPH ，临床上显著门脉高压;
    TE ，瞬时弹性;
    美国，超声检查;
    LS ，肝脏硬度;
    LSP时，肝脏硬度*脾脏长径/血小板比值;
    VRS ，静脉曲张风险评分;
    综合调查，门脉高压症风险评分;
    INR ，国际标准化比值;
    体重指数，体重指数

关键词

    瞬时弹性;
    HVPG ;
    肝病;
    食管静脉曲张;
    代偿期肝硬化;
    非侵入性诊断

通讯作者联系信息
    通讯作者。地址：肝组，内部部门的医学，医院Universitari瓦尔德希伯伦的Passeig瓦尔德希伯伦119 ， 08035巴塞罗那，西班牙。电话： +34 93 274 6140 。

版权所有© 2013欧洲肝脏研究协会的研究。发布时间由Elsevier爱尔兰有限公司保留所有权利。