Ferrusquía-Acosta José, Bassegoda Octavi, Turco Laura, Reverter Enric, Pellone Monica, Bianchini Marcello, Pérez-Campuzano Valeria, Ripoll Enric, García-Criado Ángeles, Graupera Isabel, García-Pagán Juan Carlos, Schepis Filippo, Senzolo Marco, Hernández-Gea Virginia
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain; Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
J Hepatol. 2021 Apr;74(4):811-818. doi: 10.1016/j.jhep.2020.10.003. Epub 2020 Oct 14.
BACKGROUND & AIMS: Wedge hepatic vein pressure (WHVP) accurately estimates portal pressure (PP) in alcohol- or viral hepatitis-related cirrhosis. Whether this also holds true in cirrhosis caused by non-alcoholic steatohepatitis (NASH) is unknown. We aimed to evaluate the agreement between WHVP and PP in patients with NASH cirrhosis in comparison to patients with alcohol- or HCV-related cirrhosis.
All consecutive patients with NASH cirrhosis treated with a transjugular intrahepatic portosystemic shunt (TIPS) in 3 European centres were included (NASH group; n = 40) and matched with 2 controls (1 with alcohol-related and 1 with HCV-related cirrhosis) treated with TIPS contemporaneously (control group; n = 80). Agreement was assessed by Pearson's correlation (R), intra-class correlation coefficient (ICC), and Bland-Altman method. Disagreement between WHVP and PP occurred when both pressures differed by >10% of PP value. A binary logistic regression analysis was performed to identify factors associated with this disagreement.
Correlation between WHVP and PP was excellent in the control group (R 0.92; p <0.001; ICC 0.96; p <0.001) and moderate in the NASH group (R 0.61; p <0.001; ICC 0.74; p <0.001). Disagreement between WHVP and PP was more frequent in the NASH group (37.5% vs. 14%; p = 0.003) and was mainly because of PP underestimation. In uni- and multivariate analyses, only NASH aetiology was associated with disagreement between WHVP and PP (odds ratio 4.03; 95% CI 1.60-10.15; p = 0.003).
In patients with decompensated NASH cirrhosis, WHVP does not estimate PP as accurately as in patients with alcohol- or HCV-related cirrhosis, mainly because of PP underestimation. Further studies aimed to assess this agreement in patients with compensated NASH cirrhosis are needed.
Portal pressure is usually assessed by measuring wedge hepatic vein pressure because of solid evidence demonstrating their excellent agreement in alcohol- and viral hepatitis-related cirrhosis. Our results show that in patients with decompensated cirrhosis caused by non-alcoholic steatohepatitis, wedge hepatic vein pressure estimates portal pressure with less accuracy than in patients with other aetiologies of cirrhosis, mainly because of portal pressure underestimation.
在酒精性或病毒性肝炎相关肝硬化中，肝静脉楔压（WHVP）能准确估算门静脉压力（PP）。在非酒精性脂肪性肝炎（NASH）所致肝硬化中是否同样如此尚不清楚。我们旨在评估NASH肝硬化患者中WHVP与PP之间的一致性，并与酒精性或丙型肝炎病毒（HCV）相关肝硬化患者进行比较。
纳入欧洲3个中心所有接受经颈静脉肝内门体分流术（TIPS）治疗的连续性NASH肝硬化患者（NASH组；n = 40），并与同期接受TIPS治疗的2组对照患者（1组为酒精性相关肝硬化，1组为HCV相关肝硬化）进行匹配（对照组；n = 80）。通过Pearson相关性分析（R）、组内相关系数（ICC）和Bland-Altman方法评估一致性。当WHVP与PP两者相差超过PP值的10%时，判定为两者不一致。进行二元逻辑回归分析以确定与这种不一致相关的因素。
对照组中WHVP与PP之间的相关性良好（R 0.92；p <0.001；ICC 0.96；p <0.001），而NASH组中为中度相关（R 0.61；p <0.001；ICC 0.74；p <0.001）。NASH组中WHVP与PP之间的不一致更为常见（37.5% 对14%；p = 0.003），主要是由于PP被低估。在单因素和多因素分析中，只有NASH病因与WHVP和PP之间的不一致相关（比值比4.03；95%置信区间1.60 - 10.15；p = 0.003）。
在失代偿期NASH肝硬化患者中，WHVP对PP的估算不如酒精性或HCV相关肝硬化患者准确，主要原因是PP被低估。需要进一步研究以评估代偿期NASH肝硬化患者中的这种一致性。
由于有确凿证据表明在酒精性和病毒性肝炎相关肝硬化中两者一致性良好，门静脉压力通常通过测量肝静脉楔压来评估。我们的结果表明，在非酒精性脂肪性肝炎所致失代偿期肝硬化患者中，肝静脉楔压对门静脉压力的估算准确性低于其他病因所致肝硬化患者，主要原因是门静脉压力被低估。
