Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Denis Diderot Paris VII, Clichy, France.
J Hepatol. 2012 Mar;56(3):696-703. doi: 10.1016/j.jhep.2011.07.005. Epub 2011 Jul 20.
The development of portal hypertension is a common consequence of chronic liver diseases leading to the formation of esophageal and gastric varices responsible for variceal bleeding, associated with a high mortality rate, as well as other severe complications such as portosystemic encephalopathy and sepsis. Measurement of hepatic venous pressure gradient (HVPG) and upper GI endoscopy are considered the gold standards for portal hypertension assessment in patients with cirrhosis. However, both types of investigation are invasive and HVPG measurement is routinely available and/or performed with adequate standards only in expert centres. There is thus a need for non invasive methods able to predict, with acceptable diagnostic accuracy, the progression of portal hypertension toward the levels of clinically significant (i.e. HVPG ≥ 10 mmHg) and severe (HVPG ≥ 12 mmHg) as well as the presence and the size of oesophageal varices. Transient elastography (TE) is a novel non invasive technology that allows measuring liver stiffness and that has gained popularity over the past few years. Although TE has been initially proposed to assess liver fibrosis, a good correlation has been reported between liver stiffness values and HVPG as well as the presence of oesophageal varices, suggesting that it could be an interesting tool for the non invasive evaluation of portal hypertension. This review is aimed at discussing the advantages and limits of TE and the perspectives for its rationale use in clinical practice for the management of patients with portal hypertension.
门静脉高压症的发展是慢性肝病的常见后果，导致食管和胃静脉曲张的形成，这些静脉曲张负责静脉曲张出血，伴有高死亡率，以及其他严重并发症，如门脉系统脑病和脓毒症。肝静脉压力梯度（HVPG）测量和上消化道内镜检查被认为是肝硬化患者门静脉高压评估的金标准。然而，这两种类型的检查都是侵入性的，HVPG 测量通常仅在专家中心以足够的标准进行常规使用和/或进行。因此，需要有非侵入性的方法，能够以可接受的诊断准确性预测门静脉高压向临床显著水平（即 HVPG≥10mmHg）和严重水平（HVPG≥12mmHg）的进展，以及预测食管静脉曲张的存在和大小。瞬时弹性成像（TE）是一种新型的非侵入性技术，可用于测量肝脏硬度，并在过去几年中得到了普及。尽管 TE 最初被提议用于评估肝纤维化，但已经报道了肝脏硬度值与 HVPG 以及食管静脉曲张的存在之间存在良好的相关性，这表明它可能是一种用于门静脉高压无创评估的有趣工具。这篇综述旨在讨论 TE 的优点和局限性，以及在门静脉高压患者的管理中合理使用 TE 的前景。
