Matsui Teppei, Nagai Hidenari, Watanabe Gou, Yoshimine Naoyuki, Amanuma Makoto, Kobayashi Kojiro, Ogino Yuu, Mukozu Takanori, Matsukiyo Yasushi, Daido Yasuko, Wakui Noritaka, Nakano Shigeru, Shinohara Mie, Momiyama Koichi, Kudo Takehide, Maruyama Kenichi, Igarashi Yoshinori
Division of Gastroenterology and Hepatology Toho University Omori Medical Center Tokyo Japan.
Division of Gastroenterology Saiseikai Yokohamashi Tobu Hospital Yokohama Japan.
JGH Open. 2021 May 13;5(6):695-704. doi: 10.1002/jgh3.12558. eCollection 2021 Jun.
Measuring the hepatic venous pressure gradient (HVPG) is an established technique to detect increased portal pressure and predict the presence of esophageal varices (EVs); however, the risk of the test is greater than the information it provides. This study aimed to clarify the usefulness of virtual touch tissue quantification (VTQ), which assesses liver stiffness, in predicting the presence of EVs in patients with liver cirrhosis by comparing it with HVPG.
Two hundred seventeen patients with liver cirrhosis underwent VTQ, HVPG measurement, and upper endoscopy. Patients were divided into three groups: group V, hepatitis C virus liver cirrhosis ( = 40); group A, alcoholic liver cirrhosis ( = 116); and group N, other liver cirrhosis ( = 61). In each group, we performed linear regression analysis of VTQ and HVPG data. The accuracy of VTQ and HVPG measurement in predicting the presence of EVs and high-risk EVs (EV category F2 and F3) was assessed by area under the receiver operating characteristic curve (AUROC).
VTQ was significantly correlated with the HVPG in the whole patients and in each group, and both VTQ and HVPG values were significantly higher in patients with EVs and high-risk EVs than in those without. The AUROC for the presence of EVs for VTQ was 0.76 in the whole sample, 0.76 in group V, 0.79 in group A, and 0.67 in group N; and for HVPG, 0.92, 0.94, 0.93, and 0.88, respectively. For VTQ, the AUROC for the presence of high-risk EVs was 0.78 in the whole sample, 0.78 in group V, 0.73 in group A, and 0.73 in group N; and for HVPG, it was 0.85, 0.82, 0.85, and 0.82, respectively.
VTQ was reliable at predicting the presence of EVs and high-risk EVs. Therefore, we propose that VTQ is a useful, noninvasive tool for predicting the presence of EVs in daily medical care.
测量肝静脉压力梯度（HVPG）是检测门静脉压力升高和预测食管静脉曲张（EVs）存在的一项成熟技术；然而，该检查的风险大于其提供的信息。本研究旨在通过将虚拟触诊组织定量（VTQ）（一种评估肝脏硬度的方法）与HVPG进行比较，阐明其在预测肝硬化患者EVs存在方面的实用性。
217例肝硬化患者接受了VTQ、HVPG测量及上消化道内镜检查。患者分为三组：V组，丙型肝炎病毒肝硬化（n = 40）；A组，酒精性肝硬化（n = 116）；N组，其他肝硬化（n = 61）。在每组中，我们对VTQ和HVPG数据进行线性回归分析。通过受试者操作特征曲线下面积（AUROC）评估VTQ和HVPG测量在预测EVs及高危EVs（EV分类F2和F3）存在方面的准确性。
在全体患者及每组中，VTQ与HVPG均显著相关，且有EVs和高危EVs的患者的VTQ和HVPG值均显著高于无EVs和高危EVs的患者。全体样本中VTQ预测EVs存在的AUROC为0.76，V组为0.76，A组为0.79，N组为0.67；HVPG预测EVs存在的AUROC分别为0.92、0.94、0.93和0.88。对于VTQ，全体样本中预测高危EVs存在的AUROC为0.78，V组为0.78，A组为0.73，N组为0.73；HVPG预测高危EVs存在的AUROC分别为0.85、0.82、0.85和0.82。
VTQ在预测EVs和高危EVs的存在方面是可靠的。因此，我们认为VTQ是日常医疗中预测EVs存在的一种有用的非侵入性工具。
