经颈静脉肝活检评估肝静脉压力梯度与 Scheuer 肝纤维化分期：一项多中心研究。
Hepatic venous pressure gradient evaluates the Scheuer stage of liver fibrosis by transjugular liver biopsy: a multicenter study.
机构信息
Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou 730000, China.
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China.
出版信息
HPB (Oxford). 2023 Jun;25(6):644-649. doi: 10.1016/j.hpb.2023.02.006. Epub 2023 Feb 14.
BACKGROUND
Hepatic venous pressure gradient (HVPG) is the criterion for assessing sinusoidal portal hypertension. Using HVPG to assess the degree of liver fibrosis by transjugular liver biopsy (TJLB) is still being explored, as no data has been shown that portal hypertension may already be present in patients with advanced hepatic fibrosis (Scheuer stage ≥ S3). The objective of this study was to observe whether portal hypertension exists before progressing to cirrhosis (Scheuer stage = S4).
METHODS
Fifty patients who underwent TJLB and HVPG were enrolled. The correlation between Scheuer stage and HVPG was analyzed using the Pearson correlation coefficient, and the ROC curve predicted the diagnostic value of HVPG in patients with hepatic fibrosis.
RESULTS
The Scheuer stage and HVPG significantly correlated (r = 0.654, p < 0.001). The AUC of HVPG in predicting advanced liver fibrosis was 0.896, and of cirrhosis was 0.810. There were 45 patients with portal hypertension (HVPG> 5 mmHg), 12 with S3, 29 with S4; There were 42 patients with CSPH (HVPG≥ 10 mmHg), 11 with S3, and 29 with S4.
CONCLUSION
HVPG is valuable in evaluating the Scheuer stage of liver fibrosis in patients with TJLB. Portal hypertension might already exist before the progression to cirrhosis in some patients.
背景
肝静脉压力梯度（HVPG）是评估窦性门静脉高压的标准。通过经颈静脉肝活检（TJLB）使用 HVPG 来评估肝纤维化程度仍在探索中，因为没有数据表明门静脉高压可能已经存在于进展性肝纤维化（Scheuer 分期≥S3）患者中。本研究旨在观察在进展为肝硬化（Scheuer 分期=S4）之前是否存在门静脉高压。
方法
纳入 50 例接受 TJLB 和 HVPG 的患者。使用 Pearson 相关系数分析 Scheuer 分期与 HVPG 的相关性，并使用 ROC 曲线预测 HVPG 在肝纤维化患者中的诊断价值。
结果
Scheuer 分期和 HVPG 呈显著相关（r=0.654，p<0.001）。HVPG 预测晚期肝纤维化的 AUC 为 0.896，预测肝硬化的 AUC 为 0.810。有 45 例患者存在门静脉高压（HVPG>5mmHg），其中 12 例为 S3，29 例为 S4；有 42 例患者存在 CSPH（HVPG≥10mmHg），其中 11 例为 S3，29 例为 S4。
结论
HVPG 可用于评估 TJLB 患者的 Scheuer 分期肝纤维化。在某些患者中，在进展为肝硬化之前可能已经存在门静脉高压。
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