Service d'Hepato-gastro-entérologie, Pôle Digestif CHU Toulouse, Purpan 31059, Toulouse cedex, France.
J Hepatol. 2011 Nov;55(5):1017-24. doi: 10.1016/j.jhep.2011.01.051. Epub 2011 Feb 25.
BACKGROUND & AIMS: The prognosis of patients with chronic liver disease is to a great extent determined by the presence and degree of portal hypertension (PHT). Hepatic venous pressure gradient (HVPG) has been shown to be an accurate prognostic index in patients with cirrhosis. Transient elastography is a non-invasive procedure that assesses liver fibrosis through the measurement of liver stiffness (LS). In several reports, LS was found to be correlated with HVPG. LS could therefore be useful to identify patients with significant PHT. The aim of the present study was to prospectively assess and to compare the prognostic performances of LS and HVPG in patients with chronic liver disease.
One hundred patients with chronic liver disease underwent LS and HVPG measurements on the same day. Patients were thereafter followed-up for 2 years or until they experienced a complication related to their liver disease.
Within the two-year follow-up, 41 patients developed, at least, one liver disease related complication. The performances of HVPG and LS for predicting the occurrence of these complications were not significantly different: AUROC 0.815 [0.727-0.903] and 0.837 [0.754-0.920], respectively. When considering only complications related to PHT, both methods were found to be similarly accurate: AUROC 0.830 [0.751-0.910] and 0.845 [0.767-0.823], for HVPG and LS, respectively. When patients were divided in two groups according to a LS value below or above 21.1kPa, actuarial rates of remaining free of any complication at 2 years were 85.4% vs. 29.5%, respectively. When only PHT related complications were considered, these rates were 100% vs. 47.5%, respectively. The performances of LS and HVPG were also similar in the subgroup of 65 patients with cirrhosis.
LS proved as effective as HVPG in predicting clinical decompensation and PHT related complications in patients with chronic liver disease. Therefore, LS could be a valuable clinical tool to avoid invasive procedures.
慢性肝病患者的预后在很大程度上取决于门静脉高压（PHT）的存在和程度。肝静脉压力梯度（HVPG）已被证明是肝硬化患者的准确预后指标。瞬时弹性成像（TE）是一种通过测量肝硬度（LS）来评估肝纤维化的非侵入性方法。在几项报告中，LS 被发现与 HVPG 相关。因此，LS 可用于识别有明显 PHT 的患者。本研究旨在前瞻性评估并比较 LS 和 HVPG 在慢性肝病患者中的预后性能。
100 例慢性肝病患者在同一天接受 LS 和 HVPG 测量。此后，对患者进行了 2 年的随访，或直到他们出现与肝脏疾病相关的并发症。
在 2 年的随访中，41 例患者至少发生了 1 例与肝脏疾病相关的并发症。HVPG 和 LS 预测这些并发症发生的性能无显著差异：AUROC 0.815 [0.727-0.903] 和 0.837 [0.754-0.920]。当仅考虑与 PHT 相关的并发症时，两种方法的准确性相似：AUROC 0.830 [0.751-0.910] 和 0.845 [0.767-0.823]，分别为 HVPG 和 LS。当根据 LS 值低于或高于 21.1kPa 将患者分为两组时，两组患者在 2 年内无任何并发症的生存概率分别为 85.4%和 29.5%。当仅考虑与 PHT 相关的并发症时，这些概率分别为 100%和 47.5%。LS 和 HVPG 在 65 例肝硬化患者亚组中的性能也相似。
LS 在预测慢性肝病患者临床失代偿和 PHT 相关并发症方面与 HVPG 同样有效。因此，LS 可能是一种有价值的临床工具，可以避免侵入性操作。
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