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肝脏硬度检测预测丙肝肝硬化所致严重门脉高压的研究

更新时间:2009-8-4

通过测量肝静脉压力梯度是诊断门脉高压的标准方法,而且与其并发症的出现密切相关,检测肝脏硬度被作为预测肝硬化并发症的无创技术。本研究中,我们通过研究69例慢性丙肝患者,比较研究肝脏硬度和肝静脉压力梯度对门脉高压的预测价值。研究表明,在所有研究对象中,肝脏硬度和肝静脉压力梯度是密切相关的(r=0.81, P<0.0001)。对于肝静脉压力梯度低于10mmhg或者12mmhg者,肝静脉压力梯度与门脉高压是密切相关的(r=0.81, P=0.0003 r=0.91, P<0.0001,),对于肝静脉压力梯度高于或等于10mmhg或者12mmhg者,线性回归分析不是最优的分析方法,其诊断门脉高压的ROC曲线下面积分别为0.990.92。肝脏硬度值在cut-off值为13.6 kPa 17.6 kPa时,其灵敏度分别为97% 94%。对于肝硬化病人,肝脏硬度与食管静脉曲张是确实相关的,尽管食管静脉曲张的程度与肝脏硬度没有相关性。肝脏硬度诊断食管静脉曲张的ROC曲线下面积为0.76,肝脏硬度值cut-off17.6时,其诊断的灵敏度为90%。

结论:肝脏硬度测量是临床用于诊断慢性肝病肝硬化门脉高压的无创手段,并且可以用来作为胃肠内窥镜和血液动力学研究的筛选依据。

来源: Hepatology. 2007 May;45(5):1290-7.

原文:

Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis.

Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, Petrarca A, Moscarella S, Belli G, Zignego AL, Marra F, Laffi G, Pinzani M.

Dipartimento di Medicina Interna, Center for Research, Higher Education and Transfer DENOThe, Firenze, Italy.

Measurement of hepatic venous pressure gradient (HVPG) is a standard method for the assessment of portal pressure and correlates with the occurrence of its complications. Liver stiffness measurement (LSM) has been proposed as a noninvasive technique for the prediction of the complications of cirrhosis. In this study, we evaluated the ability of LSM to predict severe portal hypertension compared with that of HVPG in 61 consecutive patients with HCV-related chronic liver disease. A strong relationship between LSM and HVPG measurements was found in the overall population (r=0.81, P<0.0001). However, although the correlation was excellent for HVPG values less than 10 or 12 mm Hg (r=0.81, P=0.0003 and r=0.91, P<0.0001, respectively), linear regression analysis was not optimal for HVPG values>or=10 mm Hg (r2=0.35, P<0.0001) or>or=12 mm Hg (r2=0.17, P=0.02). The AUROC for the prediction of HVPG>or=10 and >or=12 mm Hg were 0.99 and 0.92, respectively and at LSM cutoff values of 13.6 kPa and 17.6 kPa, sensitivity was 97% and 94%, respectively. In patients with cirrhosis, LSM positively correlated with the presence of esophageal varices (P=0.002), although no correlation between LSM and esophageal varices size was detected. The area under the ROC for the prediction of EV was 0.76 and at a LSM cutoff value of 17.6 kPa sensitivity was 90%.

CONCLUSION: LSM represents a non-invasive tool for the identification of chronic liver disease patients with clinically significant or severe portal hypertension and could be employed for screening patients to be subjected to standard investigations including upper GI endoscopy and hemodynamic studies.

PMID: 17464971 [PubMed - indexed for MEDLINE]

 

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