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为丙型肝炎患者检测肝硬化实施更好的标准仪器。

Implementing Better Standard Instruments for Detecting Cirrhosis in Hepatitis C Patients.

作者信息

Fagala Mark D, Shpak Yakov

机构信息

Clinical Research, Saba University School of Medicine, The Bottom, BES.

Clinical Research, Staten Island University Hospital/Zucker School of Medicine Hofstra/Northwell, Staten Island, USA.

出版信息

Cureus. 2023 Sep 3;15(9):e44597. doi: 10.7759/cureus.44597. eCollection 2023 Sep.

Abstract

An increasing number of hepatitis C diagnoses in the younger population could partly be due to the rising opioid epidemic and intravenous drug use. Using hepatic venous portal gradient (HVPG) and liver stiffness tests, this study investigates better early diagnostic markers in identifying cirrhosis-related complications compared to percutaneous liver biopsy in hepatitis C patients. Scholarly journal articles were surveyed using PubMed and MeSH terms. Articles published more than 15 years ago were excluded. Various databases from the New England Journal of Medicine and the Centers for Disease Control and Prevention were also referenced to support the hypothesis. There is substantial affirmation from cohort and clinical studies that transient elastography and HVPG can indicate advancing chronic inflammatory and fibrotic stages of cirrhosis in comparison to liver biopsy. Additionally, they are helpful in predicting overall mortality from complications such as esophageal varices. The use of liver stiffness measurements and HVPG appears to be equivalent and/or superior to liver biopsy in assessing advancing cirrhosis. As hepatitis C cases continue to rise, it is crucial to search for alternative methods to better suit the needs of the patients and to improve their overall prognosis and potential treatments. Liver biopsy as the gold standard for cirrhosis assessment is questionable when less invasive instrumental tools are available in practice that have been shown to predict progressing fibrosis.

摘要

年轻人群中丙型肝炎诊断病例的增加,部分原因可能是阿片类药物流行加剧和静脉注射吸毒。本研究使用肝静脉门静脉梯度(HVPG)和肝脏硬度检测,旨在探究与丙型肝炎患者经皮肝活检相比,用于识别肝硬化相关并发症的更好的早期诊断标志物。使用PubMed和医学主题词表(MeSH)检索学术期刊文章。排除15年以上发表的文章。还参考了《新英格兰医学杂志》和疾病控制与预防中心的各种数据库以支持该假设。队列研究和临床研究充分证实,与肝活检相比,瞬时弹性成像和HVPG能够显示肝硬化慢性炎症和纤维化进展阶段。此外,它们有助于预测诸如食管静脉曲张等并发症导致的总体死亡率。在评估肝硬化进展方面,肝脏硬度测量和HVPG的应用似乎等同于和/或优于肝活检。随着丙型肝炎病例持续增加,寻找更适合患者需求、改善其总体预后及潜在治疗方法的替代方法至关重要。当实践中已有侵入性较小且已被证明可预测纤维化进展的仪器工具时,将肝活检作为肝硬化评估的金标准受到质疑。

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