Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, 90127 Palermo, Italy.
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
Medicina (Kaunas). 2024 Apr 24;60(5):690. doi: 10.3390/medicina60050690.
Clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease indicates an increased risk of decompensation and death. While invasive methods like hepatic venous-portal gradient measurement is considered the gold standard, non-invasive tests (NITs) have emerged as valuable tools for diagnosing and monitoring CSPH. This review comprehensively explores non-invasive diagnostic modalities for portal hypertension, focusing on NITs in the setting of hepatitis B and hepatitis C virus-related cirrhosis. Biochemical-based NITs can be represented by single serum biomarkers (e.g., platelet count) or by composite scores that combine different serum biomarkers with each other or with demographic characteristics (e.g., FIB-4). On the other hand, liver stiffness measurement and spleen stiffness measurement can be assessed using a variety of elastography techniques, and they can be used alone, in combination with, or as a second step after biochemical-based NITs. The incorporation of liver and spleen stiffness measurements, alone or combined with platelet count, into established and validated criteria, such as Baveno VI or Baveno VII criteria, provides useful tools for the prediction of CSPH and for ruling out high-risk varices, potentially avoiding invasive tests like upper endoscopy. Moreover, they have also been shown to be able to predict liver-related events (e.g., the occurrence of hepatic decompensation). When transient elastography is not available or not feasible, biochemical-based NITs (e.g., RESIST criteria, that are based on the combination of platelet count and albumin levels) are valid alternatives for predicting high-risk varices both in patients with untreated viral aetiology and after sustained virological response. Ongoing research should explore novel biomarkers and novel elastography techniques, but current evidence supports the utility of routine blood tests, LSM, and SSM as effective surrogates in diagnosing and staging portal hypertension and predicting patient outcomes.
临床上，代偿期慢性肝病进展期患者出现显著门静脉高压症（CSPH）提示其发生失代偿和死亡的风险增加。尽管肝静脉-门静脉梯度测量等有创方法被认为是金标准，但非侵入性检查（NIT）已成为诊断和监测 CSPH 的重要工具。本综述全面探讨了门静脉高压症的非侵入性诊断方法，重点介绍了乙型肝炎和丙型肝炎病毒相关肝硬化背景下的 NIT。基于生化的 NIT 可由单个血清标志物（如血小板计数）或由将不同血清标志物相互组合或与人口统计学特征（如 FIB-4）相结合的综合评分来代表。另一方面，肝硬度和脾脏硬度可以通过各种弹性成像技术进行评估，它们可以单独使用，也可以与生化 NIT 结合使用，或者作为生化 NIT 之后的第二步使用。将肝脏和脾脏硬度测量值单独或与血小板计数结合起来，纳入 Baveno VI 或 Baveno VII 等已建立和验证的标准中，为 CSPH 的预测和高危静脉曲张的排除提供了有用的工具，从而可能避免上消化道内镜等有创检查。此外，它们还被证明能够预测与肝脏相关的事件（例如，肝失代偿的发生）。当瞬时弹性成像不可用或不可行时，基于生化的 NIT（例如，基于血小板计数和白蛋白水平组合的 RESIST 标准）是预测未治疗病毒病因和持续病毒学应答后高危静脉曲张的有效替代方法。正在进行的研究应探索新型生物标志物和新型弹性成像技术，但现有证据支持常规血液检查、LSM 和 SSM 在诊断和分期门静脉高压症以及预测患者预后方面的实用性。
