中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肝硬化门静脉高压的无创评估

穆雪纯 王宇 马红

引用本文:
Citation:

肝硬化门静脉高压的无创评估

DOI: 10.3969/j.issn.1001-5256.2019.12.033
基金项目: 

中国肝炎防治基金会王宝恩肝纤维化研究基金(2019060); 

详细信息
  • 中图分类号: R575.2

Noninvasive assessment of cirrhotic portal hypertension

Research funding: 

 

  • 摘要: 肝静脉压力梯度测定(HVPG)是反映肝硬化门静脉高压程度的金标准,但其临床应用有一定限制,迫切需要门静脉高压的无创评估方法。简述了血清学、影像学、弹性成像等方法以及联合诊断模型,评述了现有的研究结果及不同方法的优缺点,认为无创诊断技术未来有可能在肝硬化门静脉高压患者的筛查监测和风险分层中起到更大的作用。

     

  • [1] TSOCHATZIS EA,BOSCH J,BURROUGHS AK. Liver cirrhosis[J]. Lancet,2014,383(9930):1749-1761.
    [2] BLOOM S,KEMP W,LUBEL J. Portal hypertension:Pathophysiology,diagnosis and management[J]. Intern Med J,2015,45(1):16-26.
    [3] ONO H,MAWATARI H,MIZOGUCHI N,et al. Clinical features and outcome of eight infants with intrahepatic porto-venous shunts detected in neonatal screening for galactosaemia[J]. Acta Paediatr,1998,87(6):631-634.
    [4] 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[J]. Hepatology,2017,65(1):310-335.
    [5] BOSCH J,ABRALDES JG,BERZIGOTTI A,et al. The clinical use of HVPG measurements in chronic liver disease[J]. Nat Rev Gastroenterol Hepatol,2009,6(10):573-582.
    [6] SUTTON H,DHAWAN A,GRAMMATIKOPOULOS T. Non-invasive markers of portal hypertension:Appraisal of adult experience and potential utilisation in children[J]. J Pediatr Gastroenterol Nutr,2018,66(4):559-569.
    [7] DU JH,NAN YM. Novel molecular diagnostic markers for liver fibrosis[J]. J Clin Hepatol,2017,33(3):445-450.(in Chinese)杜静华,南月敏.肝纤维化新型分子诊断标志物[J].临床肝胆病杂志,2017,33(3):445-450.
    [8] LEEMING DJ,KARSDAL MA,BYRJALSEN I,et al. Novel serological neo-epitope markers of extracellular matrix proteins for the detection of portal hypertension[J]. Aliment Pharmacol Ther,2013,38(9):1086-1096.
    [9] BRUHA R,JACHYMOVA M,PETRTYL J,et al. Osteopontin:A non-invasive parameter of portal hypertension and prognostic marker of cirrhosis[J]. World J Gastroenterol,2016,22(12):3441-3450.
    [10] WANG L,FENG Y,MA X,et al. Diagnostic efficacy of noninvasive liver fibrosis indexes in predicting portal hypertension in patients with cirrhosis[J]. PLo S One, 2017, 12(8):e0182969.
    [11] BUCK M,GARCIA-TSAO G,GROSZMANN RJ,et al. Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients[J]. Hepatology,2014,59(3):1052-1059.
    [12] SANDAHL TD,McGRAIL R,MOLLER 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[J]. Aliment Pharmacol Ther,2016,43(11):1222-1231.
    [13] LISOTTI A,AZZAROLI F,CUCCHETTI A,et al. Relationship between indocyanine green retention test, decompensation and survival in patients with Child-Pugh A cirrhosis and portal hypertension[J]. Liver international,2016,36(9):1313-1321.
    [14] LIM YL,CHOI E,JANG YO,et al. Clinical implications of the serum apelin level on portal hypertension and prognosis of liver cirrhosis[J]. Gut liver,2016,10(1):109-116.
    [15] FERLITSCH M,REIBERGER T,HOKE M,et al. von Willebrand factor as new noninvasive predictor of portal hypertension,decompensation and mortality in patients with liver cirrhosis[J].Hepatology,2012,56(4):1439-1447.
    [16] 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[J]. PLo S One,2016,11(2):e0149230.
    [17] KIM MY,BAIK SK,PARK DH,et al. Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis:A prospective nonrandomized study[J]. Liver Int,2007,27(8):1103-1110.
    [18] VIZZUTTI F,ARENA U,REGA L,et al. Performance of Doppler ultrasound in the prediction of severe portal hypertension in hepatitis C virus-related chronic liver disease[J]. Liver Int,2007,27(10):1379-1388.
    [19] ZHU YJ,WANG Y,HUANG JL,et al. Current status and progress in noninvasive assessment of portal pressure[J]. J Clin Hepatol,2014,30(7):608-611.(in Chinese)朱炎杰,王勇,黄家乐,等.门静脉压力的无创性评估现状及进展[J].临床肝胆病杂志,2014,30(7):608-611.
    [20] RAVAIOLI F,MONTAGNANI M,LISOTTI A,et al. Noninvasive assessment of portal hypertension in advanced chronic liver disease:An update[J]. Gastroenterol Res Pract,2018,2018:4202091.
    [21] IRANMANESH P,VAZQUEZ O,TERRAZ S,et al. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma[J]. J Hepatol,2014,60(5):969-974.
    [22] QI X,LI Z,HUANG J,et al. Virtual portal pressure gradient from anatomic CT angiography[J]. Gut,2015,64(6):1004-1005.
    [23] HWANG J,KIM Y,LEE W,et al. Unenhanced magnetic resonance portography using repetitive arterial or vein labeling method at 3. 0-T[J]. J Comput Assist Tomogr,2013,37(6):856-861.
    [24] PALANIYAPPAN N,COX E,BRADLEY C,et al. Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging[J]. J Hepatol,2016,65(6):1131-1139.
    [25] WAGNER M,HECTORS S,BANE O,et al. Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen:Preliminary results[J]. J Magn Reson Imaging,2018,48(4):1091-1103.
    [26] ROLDN-ALZATE A,FRYDRYCHOWICZ A,NIESPODZANY E,et al. In vivo validation of 4D flow MRI for assessing the hemodynamics of portal hypertension[J]. J Magn Reson Imaging,2013,37(5):1100-1108.
    [27] SINGH S,FUJII LL,MURAD MH,et al. Liver stiffness is associated with risk of decompensation,liver cancer,and death in patients with chronic liver diseases:A systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol,2013,11(12):1573-1584. e1-e2; quiz e88-e89.
    [28] KONDO R,KAGE M,IIJIMA H,et al. Pathological findings that contribute to tissue stiffness in the spleen of liver cirrhosis patients[J]. Hepatol Res,2018,48(12):1000-1007.
    [29] CASTERA L,PINZANI M,BOSCH J. Non invasive evaluation of portal hypertension using transient elastography[J]. J Hepatol,2012,56(3):696-703.
    [30] DIETRICH CF,BAMBER J,BERZIGOTTI A,et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography,Update 2017(Long Version)[J].Ultraschall Med,2017,38(4):e48.
    [31] BAMBER J,COSGROVE D,DIETRICH CF,et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1:Basic principles and technology[J]. Ultraschall Med,2013,34(2):169-184.
    [32] VIZZUTTI F,ARENA U,ROMANELLI RG,et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis[J]. Hepatology,2007,45(5):1290-1297.
    [33] YOU MW,KIM KW,PYO J,et al. A Meta-analysis for the diagnostic performance of transient elastography for clinically significant portal hypertension[J]. Ultrasound Med Biol,2017,43(1):59-68.
    [34] COLECCHIA A,MONTRONE L,SCAIOLI E,et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis[J]. Gastroenterology,2012,143(3):646-654.
    [35] ELKRIEF L,RAUTOU PE,RONOT M,et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis[J]. Radiology,2015,275(2):589-598.
    [36] SALZL P,REIBERGER T,FERLITSCH M,et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J]. Ultraschall Med,2014,35(6):528-533.
    [37] ICHIKAWA S,MOTOSUGI U,MORISAKA H,et al. Comparison of the diagnostic accuracies of magnetic resonance elastography and transient elastography for hepatic fibrosis[J].Magn Reson Imaging,2015,33(1):26-30.
    [38] NIU M,DENG DY,LI YPF,et al. Values of MRE in diagnosis of stages of hepatic fibrosis:A Meta-analysis[J]. J Jilin Univ(Med Edit),2017,43(4):787-793.(in Chinese)牛猛,邓大勇,李云鹏飞,等.磁共振弹性成像对肝纤维化分级诊断价值的Meta分析[J].吉林大学学报(医学版),2017,43(4):787-793.
    [39] TALWALKAR JA,YIN M,VENKATESH S,et al. Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension[J]. AJR Am J Roentgenol,2009,193(1):122-127.
    [40] GHARIB AM,HAN M,MEISSNER EG,et al. Magnetic resonance elastography shear wave velocity correlates with liver fibrosis and hepatic venous pressure gradient in adults with advanced liver disease[J]. Biomed Res Int, 2017, 2017:2067479.
    [41] GUO J,BNING C,SCHOTT E,et al. In vivo abdominal magnetic resonance elastography for the assessment of portal hypertension before and after transjugular intrahepatic portosystemic shunt implantation[J]. Invest Radiol,2015,50(5):347-351.
    [42] RONOT M,LAMBERT S,ELKRIEF L,et al. Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis[J]. Eur Radiol,2014,24(6):1394-1402.
    [43] LLOP E,LOPEZ M,de la REVILLA J,et al. Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease[J]. J Gastroenterol Hepatol,2017,32(11):1867-1872.
    [44] BERZIGOTTI A,SEIJO S,ARENA U,et al. Elastography,spleen size,and platelet count identify portal hypertension in patients with compensated cirrhosis[J]. Gastroenterology,2013,144(1):102-111. e1.
    [45] 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]. J Hepatol,2018,69(2):308-317.
    [46] ABRALDES JG,BUREAU C,STEFANESCU H,et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis:The“Anticipate”study[J]. Hepatology,2016,64(6):2173-2184.
  • 加载中
计量
  • 文章访问数:  1061
  • HTML全文浏览量:  36
  • PDF下载量:  248
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-07-23
  • 出版日期:  2019-12-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回