Vizzutti Francesco, Arena Umberto, Romanelli Roberto G, Rega Luigi, Foschi Marco, Colagrande Stefano, Petrarca Antonio, Moscarella Stefania, Belli Giacomo, Zignego Anna Linda, Marra Fabio, Laffi Giacomo, Pinzani Massimo
Dipartimento di Medicina Interna, Center for Research, Higher Education and Transfer DENOThe, Firenze, Italy.
Hepatology. 2007 May;45(5):1290-7. doi: 10.1002/hep.21665.
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%.
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.
肝静脉压力梯度（HVPG）测量是评估门静脉压力的标准方法，且与门静脉高压并发症的发生相关。肝脏硬度测量（LSM）已被提出作为预测肝硬化并发症的一种非侵入性技术。在本研究中，我们在61例连续的丙型肝炎病毒（HCV）相关慢性肝病患者中，评估了LSM与HVPG相比预测严重门静脉高压的能力。在总体人群中发现LSM与HVPG测量值之间存在很强的相关性（r = 0.81，P < 0.0001）。然而，尽管对于HVPG值小于10或12 mmHg时相关性极佳（分别为r = 0.81，P = 0.0003和r = 0.91，P < 0.0001），但对于HVPG值≥10 mmHg（r2 = 0.35，P < 0.0001）或≥12 mmHg（r2 = 0.17，P = 0.02），线性回归分析并非最佳。预测HVPG≥10和≥12 mmHg的受试者工作特征曲线下面积（AUROC）分别为0.99和0.92，在LSM临界值为13.6 kPa和17.6 kPa时，敏感性分别为97%和94%。在肝硬化患者中，LSM与食管静脉曲张的存在呈正相关（P = 0.002），尽管未检测到LSM与食管静脉曲张大小之间的相关性。预测食管静脉曲张的ROC曲线下面积为0.76，在LSM临界值为17.6 kPa时敏感性为90%。
LSM是一种用于识别具有临床显著或严重门静脉高压的慢性肝病患者的非侵入性工具，可用于筛查患者以进行包括上消化道内镜检查和血流动力学研究在内的标准检查。
