肝脏硬度和临床显著门脉高压门脉高压并发症的预测

StephenW

Liver and biliary tract
Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications

April 2015, Vol. 50, No. 4 , Pages 462-469 (doi:10.3109/00365521.2014.964758)

   
Matthew T. Kitson, Stuart K. Roberts, John C. Colman, Eldho Paul, Peter Button, and William Kemp
1Department of Gastroenterology, Alfred Hospital,
Melbourne, Australia
2Department of Gastroenterology, Monash University,Melbourne, Australia
3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
4Infopeople Pty Ltd.,Sydney, Australia
Correspondence: Matthew T. Kitson, Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne VIC 3004, Australia. +61 3 90763375. +61 3 90762194. [email protected]


Abstract

Objective. Clinically significant portal hypertension (CSPH) is associated with increased risk of liver disease complications, but its identification requires invasive methods. Liver stiffness (LS) measurement via transient elastography correlates with the presence of CSPH. We, therefore, evaluated LS as a noninvasive tool in the prediction of CSPH and portal hypertensive complications. Material and methods. Ninety-five consecutive patients successfully underwent measurement of hepatic venous pressure gradient (HVPG) and LS on the same day. Recent laboratory tests were correlated. Patients were followed up for development of portal hypertensive complications. Predictors of CSPH and complications were identified. Results. Seventy-six (80%) were male and mean age was 56.8 ± 9.3 years. Ninety-three percent and 72% of patients had cirrhosis and esophageal varices, respectively. Only LS (r2 = 0.38; p < 0.0001) and international normalized ratio (r2 = 0.21; p = 0.02) were independently associated with HVPG. An LS >29.0 kilopascal (kPa) predicted CSPH with 71.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 56.0% negative predictive value (NPV). An LS <25.0 kPa in those with platelet count >150 × 109/L excluded CSPH with 91.7% sensitivity, 100% specificity, 100% PPV, and 90% NPV. Ninety patients were followed up for a median duration of 15.1 months. CSPH and LS >34.5 kPa predicted portal hypertensive complications with 100% and 75.0% sensitivity, 40.3% and 69.4% specificity, 43.1% and 52.5% PPV, and 100% and 86.2% NPV, respectively. Conclusion. LS shows promise as a noninvasive marker of CSPH and portal hypertensive complications. Combining LS with platelet count improves diagnostic accuracy in the exclusion of CSPH.
Keywords
decompensation, liver disease, liver stiffness, portal hypertension, transient elastograph



Read More: http://informahealthcare.com/doi/abs/10.3109/00365521.2014.964758

StephenW

肝脏和胆道
肝脏硬度和临床显著门脉高压门脉高压并发症的预测

2015年4月，卷。 50，4号，页462-469（DOI：10.3109 / 00365521.2014.964758）

   
马修T.基特森，斯图尔特K.罗伯茨，约翰·C·科尔曼，Eldho保罗，彼得·巴顿和威廉·肯普
教研室消化，阿尔弗雷德医院，
澳大利亚墨尔本
消化内科，莫纳什大学，墨尔本，澳大利亚教研室
流行病学和预防医学，莫纳什大学，墨尔本，澳大利亚3Department
4Infopeople控股有限公司，澳大利亚悉尼
函授：马修T.基特森，消化内科，阿尔弗雷德医院部，
55商业路，墨尔本VIC 3004
，澳大利亚。 +61 3 90763375. +61 3 90762194. [email protected]


抽象

客观的。临床显著门脉高压（CSPH）与肝病并发症的风险增加有关，但其识别需要侵入性的方法。通过瞬时弹性肝脏硬度（LS）测量相关用部CSPH的存在。因此，我们评估LS在CSPH和门脉高压并发症的预测的非侵入性的工具。材料和方法。九十五例患者成功地进行了肝静脉压力梯度（HVPG）和LS的测量在同一天。最近的化验呈正相关。患者随访的门脉高压并发症的发展。 CSPH和并发症的预测进行了鉴定。结果。七十六（80％）为男性，平均年龄为56.8±9.3年。百分之九十三的患者72％有肝硬化食管静脉曲张，分别。仅LS（R2 = 0.38，P <0.0001）和国际标准化比值（R2 = 0.21; P = 0.02）独立与HVPG相关联。一个LS> 29.0千帕（kPa）的预测CSPH有71.9％的敏感性，特异性为100％，100％，阳性预测值（PPV）和56.0％阴性预测值（NPV）。一个LS <25.0千帕在那些与血小板计数> 150×109 / L的排除部CSPH与91.7％的敏感性，特异性为100％，100％，PPV和90％的净现值。 90例随访15.1个月时间中位数。 CSPH和LS> 34.5千帕预测门脉高压并发症分别为100％和75.0％的敏感性，40.3％和69.4％的特异性，43.1％和52.5％，PPV，100％和86.2％，NPV。结论。 LS有望作为CSPH的非侵入性的标记，门脉高压并发症。血小板计数结合LS提高了CSPH排除诊断的准确性。
关键词
失代偿，肝病，肝脏硬度，门脉高压症，短暂elastograph