Postgraduate Trainee; Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital, Tripura, Agartala, India.
Professor, Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital, Tripura, Agartala, India; Corresponding Author.
J Assoc Physicians India. 2022 Jun;70(6):11-12. doi: 10.5005/japi-11001-0018.
Chronic liver disease (CLD) represents different liver disorders of varying severity and etiology in which hepatic inflammation and fibrosis continue at least for 6 months. Portal hypertension is one of the important complications of CLD and its early recognition is of paramount importance. Though liver biopsy remains the gold standard for diagnosing liver fibrosis and upper gastrointestinal (GI) endoscopy plays an important role in diagnosing different findings of portal hypertension, various noninvasive methods like FibroScan are being increasingly used to diagnose liver fibrosis.
Study the FibroScan and endoscopic findings in patients of CLDs and the objectives are to find the prevalence of portal hypertension and to find various grades of esophageal varix and portal hypertensive gastropathy (PHG) and its relationship with liver fibrosis by FibroScan.
A total of 114 patients of CLD and compensated cirrhosis having childturcotte- pugh (CTP) stages A and B were included in the study fulfilling inclusion and exclusion criteria, after calculating the sample size of 100. All the patients underwent detailed history, physical and gastrointestinal examination. Complete blood count (CBC), liver function test (LFT), kidney function test (KFT), viral markers were done. Aspartate aminotransferase (AST) to platelet ratio index (APRI) score was calculated, liver fibrosis was estimated by FibroScan and evidence of portal hypertension was documented by upper GI endoscopy. Cutoff value of FibroScan, APRI score, and model for end-stage liver disease (MELD) score for portal hypertension was decided by receiver operating characteristic (ROC) curve.
Alcoholic liver disease (ALD) was the most common cause (43%) of CLD closely followed by nonalcoholic fatty liver disease (NAFLD) in 42% cases followed by chronic viral hepatitis, 75% patients had evidence of portal hypertension with PHG being the most common followed by esophageal varix. F4 fibrosis was found in 73% of cases followed by F3, F2, and F1 fibrosis. FibroScan value of 12.2 kPa was predictive of presence of portal hypertension and value of 26.6 mm predicted the presence of large esophageal varices.
慢性肝病（CLD）代表了不同严重程度和病因的肝脏疾病，其特点是肝炎症和纤维化至少持续 6 个月。门静脉高压症是 CLD 的重要并发症之一，早期识别至关重要。虽然肝活检仍然是诊断肝纤维化的金标准，上消化道（GI）内镜在诊断门静脉高压的各种发现方面发挥着重要作用，但 FibroScan 等各种非侵入性方法也越来越多地用于诊断肝纤维化。
研究 CLD 患者的 FibroScan 和内镜检查结果，目的是发现门静脉高压的患病率，并通过 FibroScan 发现各种程度的食管静脉曲张和门静脉高压性胃病（PHG）及其与肝纤维化的关系。
共纳入 114 例符合纳入和排除标准的 CLD 患者和代偿性肝硬化患者，Childturcotte-Pugh（CTP）分期为 A 和 B，计算样本量为 100 例。所有患者均接受详细的病史、体格和胃肠道检查。完成全血细胞计数（CBC）、肝功能检查（LFT）、肾功能检查（KFT）、病毒标志物检查。计算天冬氨酸转氨酶（AST）与血小板比值指数（APRI）评分，通过 FibroScan 估计肝纤维化，通过上消化道内镜记录门静脉高压的证据。通过受试者工作特征（ROC）曲线确定 FibroScan、APRI 评分和终末期肝病模型（MELD）评分的截断值，以预测门静脉高压。
酒精性肝病（ALD）是最常见的 CLD 病因（43%），紧随其后的是非酒精性脂肪性肝病（NAFLD），占 42%，其次是慢性病毒性肝炎，75%的患者有门静脉高压的证据，最常见的是 PHG，其次是食管静脉曲张。73%的病例发现 F4 纤维化，其次是 F3、F2 和 F1 纤维化。FibroScan 值为 12.2 kPa 可预测门静脉高压的存在，值为 26.6 mm 可预测大食管静脉曲张的存在。
