Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Gastroenterology. 2012 Sep;143(3):646-654. doi: 10.1053/j.gastro.2012.05.035. Epub 2012 May 27.
BACKGROUND & AIMS: The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests.
We measured SS and LS in 100 consecutive patients with hepatitis C virus-induced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LS-spleen diameter to platelet ratio score and platelet count to spleen diameter.
SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values (R(2) = 0.85). The results were internally validated using bootstrap analysis.
Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus-induced cirrhosis.
肝静脉压力梯度（HVPG）是用于确定门静脉高压（PH）程度的标准，也是肝硬化患者的重要预后因素；HVPG 值与食管静脉曲张（EV）的存在相关。然而，HVPG 只能在专业中心准确确定；需要非侵入性方法来预测 HVPG 值和 EV 的存在。我们比较了瞬时弹性成像测量的脾脏硬度（SS）与肝硬度（LS）和其他最近提出的非侵入性测试的诊断性能。
我们对 100 例丙型肝炎病毒诱导的肝硬化连续患者进行了 SS 和 LS 测量。还通过 FibroScan、HVPG、食管胃十二指肠镜和肝活检对患者进行了评估。我们还分析了 LS-脾脏直径比值评分和血小板计数与脾脏直径的比值。
SS 和 LS 在识别 EV 和不同程度 PH 的患者方面比其他非侵入性参数更准确。包含 SS 和 LS 的线性模型可以准确预测 HVPG 值（R²=0.85）。使用自举分析对内部分析进行了验证。
SS 的测量可用于非侵入性评估和监测 PH，并检测丙型肝炎病毒诱导的肝硬化患者的 EV。
