Kitson Matthew T, Roberts Stuart K, Colman John C, Paul Eldho, Button Peter, Kemp William
Department of Gastroenterology, Alfred Hospital , Melbourne , Australia.
Scand J Gastroenterol. 2015 Apr;50(4):462-9. doi: 10.3109/00365521.2014.964758. Epub 2015 Jan 26.
Clinically significant portal hypertension (CSPH) is associated with increased risk of liver disease complications, but its identification requires invasive methods. Liver stiffness (LS) measurement via transient elastography correlates with the presence of CSPH. We, therefore, evaluated LS as a noninvasive tool in the prediction of CSPH and portal hypertensive complications.
Ninety-five consecutive patients successfully underwent measurement of hepatic venous pressure gradient (HVPG) and LS on the same day. Recent laboratory tests were correlated. Patients were followed up for development of portal hypertensive complications. Predictors of CSPH and complications were identified.
Seventy-six (80%) were male and mean age was 56.8 ± 9.3 years. Ninety-three percent and 72% of patients had cirrhosis and esophageal varices, respectively. Only LS (r(2) = 0.38; p < 0.0001) and international normalized ratio (r(2) = 0.21; p = 0.02) were independently associated with HVPG. An LS >29.0 kilopascal (kPa) predicted CSPH with 71.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 56.0% negative predictive value (NPV). An LS <25.0 kPa in those with platelet count >150 × 10(9)/L excluded CSPH with 91.7% sensitivity, 100% specificity, 100% PPV, and 90% NPV. Ninety patients were followed up for a median duration of 15.1 months. CSPH and LS >34.5 kPa predicted portal hypertensive complications with 100% and 75.0% sensitivity, 40.3% and 69.4% specificity, 43.1% and 52.5% PPV, and 100% and 86.2% NPV, respectively.
LS shows promise as a noninvasive marker of CSPH and portal hypertensive complications. Combining LS with platelet count improves diagnostic accuracy in the exclusion of CSPH.
具有临床意义的门静脉高压（CSPH）与肝病并发症风险增加相关，但其识别需要采用侵入性方法。通过瞬时弹性成像测量肝脏硬度（LS）与CSPH的存在相关。因此，我们评估了LS作为预测CSPH和门静脉高压并发症的非侵入性工具。
95例连续患者于同一天成功接受了肝静脉压力梯度（HVPG）和LS测量。将其与近期实验室检查结果进行关联分析。对患者进行随访，观察门静脉高压并发症的发生情况。确定CSPH和并发症的预测因素。
76例（80%）为男性，平均年龄为56.8±9.3岁。分别有93%和72%的患者患有肝硬化和食管静脉曲张。仅LS（r² = 0.38；p < 0.0001）和国际标准化比值（r² = 0.21；p = 0.02）与HVPG独立相关。LS>29.0千帕斯卡（kPa）预测CSPH的敏感度为71.9%，特异度为100%，阳性预测值（PPV）为100%，阴性预测值（NPV）为56.0%。血小板计数>150×10⁹/L且LS<25.0 kPa的患者排除CSPH的敏感度为91.7%，特异度为100%，PPV为100%，NPV为90%。90例患者接受了中位时间为15.1个月的随访。CSPH和LS>34.5 kPa预测门静脉高压并发症的敏感度分别为100%和75.0%，特异度分别为40.3%和69.4%，PPV分别为43.1%和52.5%，NPV分别为100%和86.2%。
LS有望作为CSPH和门静脉高压并发症的非侵入性标志物。将LS与血小板计数相结合可提高排除CSPH的诊断准确性。
