目的:在静脉曲张发展之前检测门静脉高压(PH)对预后和设计介入研究很重要。在实践中没有使用可用的策略。我们根据临床数据和瞬时弹性成像(TE)评估了一项序贯筛查诊断策略,以检测无症状门诊患者肝病的PH。
方法:连续对慢性肝病且先前未诊断为PH的患者进行TE筛查。肝硬度(LS)13.6kPa的患者通过内窥镜检查和肝静脉压力梯度(HVPG)进一步评估。为了进行分析,患者分为3组:A组,血小板150,000/mm(3),正常腹部超声;B组,血小板<150,000/mm(3),正常超声;C组,血小板<150,000/mm(3),异常超声(脾肿大,结节性肝表面)。
结果:评估了250例患者(A组69%,20%B组,11%C组)。在9%的弹性成像中无效。在54名患者中发现了LS13.6(8%A,43%B,81%的C,p<0.001)。其中49例进行了内窥镜检查:20%有小静脉曲张,0%高危静脉曲张。A组没有患者出现静脉曲张,90%的静脉曲张属于C组。在40例患者中获得了HVPG:93%的PH(HVPG>5mmHg)和65%的临床显着PH(CSPH,HVPG10)。只有3个病人,全部来自A组,HVPG<5。来自B组和C组的所有患者均患有LS13.6。LS25截止日期在CSPH的统治方面非常出色。
结论:基于常规临床数据和TE的简单策略可用于检测无症状慢性肝病患者的早期PH。
OBJECTIVE: 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/mm(3), normal abdominal ultrasound; group B, platelets <150,000/mm(3), normal ultrasound; group C, platelets <150,000/mm(3), 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.