Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Italian Liver Foundation, Basovizza (Trieste), Italy.
Italian Liver Foundation, Basovizza (Trieste), Italy.
Ann Hepatol. 2020 Nov-Dec;19(6):691-693. doi: 10.1016/j.aohep.2020.07.004. Epub 2020 Aug 20.
Spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement. However, there is no data available regarding SS in patients with spontaneous portosystemic shunting (SPSS), especially in regards to prediction of hepatic decompensation.
We retrospectively selected patients with confirmed SPSS and esophageal varices (EVs) at endoscopic examination, and recorded any decompensating event (i.e., variceal hemorrhage, overt hepatic encephalopathy, refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome) in the first twelve months following liver and spleen elastography.
The patients who presented decompensating events showed lower platelet count (94.5 vs. 121.5 g/L, p < 0.001), higher SS (44 vs. 30 kPa, p < 0.001), higher probability of EVs according to SS (77 vs. 2 %, p < 0.001), and higher spleen diameter (14 vs. 12 cm, p = 0.043). They also showed a higher prevalence of splenorenal shunts (66.7 vs. 31.2%), and a significantly wider SPSS major diameter (14.5 vs. 8 mm, p < 0.001).
SS could predict SPSS efficacy in relieving portal pressure, and could predict decompensating events in patients with SPSS.
经颈静脉肝内门体分流术（TIPS）放置后，脾硬度（SS）被发现能反映门静脉压力的动态变化。然而，对于自发性门体分流（SPSS）患者的 SS 尚无数据，特别是在预测肝失代偿方面。
我们回顾性选择了经内镜检查确诊为 SPSS 和食管静脉曲张（EVs）的患者，并记录了肝和脾弹性成像后 12 个月内任何失代偿事件（即静脉曲张出血、显性肝性脑病、难治性腹水、自发性细菌性腹膜炎、肝肾综合征）。
出现失代偿事件的患者血小板计数较低（94.5 对 121.5 g/L，p < 0.001），SS 较高（44 对 30 kPa，p < 0.001），根据 SS 发生 EVs 的概率较高（77 对 2%，p < 0.001），脾脏直径较大（14 对 12 cm，p = 0.043）。他们也显示出更高的脾肾分流（66.7 对 31.2%）和更宽的 SPSS 主直径（14.5 对 8 毫米，p < 0.001）。
SS 可以预测 SPSS 在缓解门静脉压力方面的疗效，并可以预测 SPSS 患者的失代偿事件。
