Vanderschueren Emma, van der Merwe Schalk, Laleman Wim
Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (Emma Vanderschueren, Schalk van der Merwe, Wim Laleman).
Department of Internal Medicine B, University of Münster, Münster, Germany (Wim Laleman).
Ann Gastroenterol. 2025 Jul-Aug;38(4):380-391. doi: 10.20524/aog.2025.0980. Epub 2025 Jun 25.
The development of clinically significant portal hypertension (CSPH) represents one of the strongest predictive biomarkers for disease progression in patients with compensated advanced chronic liver disease (cACLD). Chronic liver injury triggers both intra- and extrahepatic mechanisms, giving rise to an increasing portal pressure and a self-perpetuating cycle with worsening risks of liver-related complications and mortality. Diagnosing CSPH becomes challenging in patients with advanced but compensated chronic liver disease where CSPH is not apparent clinically. Approximately 60% of patients with cACLD will have CSPH, representing a critical window for intervention to reduce portal pressure and prevent complications. The current gold standard for portal pressure measurement, the hepatic venous pressure gradient, is impractical for widespread use. Emerging diagnostic tools aim to address this limitation. Techniques such as endoscopic ultrasound-guided portal pressure gradient measurement, and noninvasive approaches using imaging methods, elastography (targeting liver and/or spleen) and serum markers, offer alternatives for CSPH detection, and moreover, can guide treatment decisions. Non-selective beta-blockers are known to reduce morbidity and mortality in patients with CSPH. Unfortunately, they remain the only approved therapy for CSPH and they are not effective in reducing portal pressure in all patients, highlighting the urgent need for additional therapeutic options as well as practical methods to evaluate treatment response. Recent innovations and ongoing research are steering the field toward a more personalized approach, where diagnosis, treatment and follow up are tailored to individual patient risk profiles. This evolution holds the potential to improve outcomes in patients with CSPH.
临床显著门静脉高压（CSPH）的发展是代偿期晚期慢性肝病（cACLD）患者疾病进展最强的预测生物标志物之一。慢性肝损伤触发肝内和肝外机制，导致门静脉压力升高，并形成一个自我持续的循环，增加肝脏相关并发症和死亡的风险。在晚期但代偿期的慢性肝病患者中，CSPH在临床上并不明显，诊断CSPH具有挑战性。约60%的cACLD患者会出现CSPH，这是降低门静脉压力和预防并发症的关键干预窗口。目前测量门静脉压力的金标准——肝静脉压力梯度，因不切实际而无法广泛应用。新兴的诊断工具旨在解决这一局限性。诸如内镜超声引导下门静脉压力梯度测量等技术，以及使用成像方法、弹性成像（针对肝脏和/或脾脏）和血清标志物的非侵入性方法，为CSPH检测提供了替代方法，而且还可以指导治疗决策。已知非选择性β受体阻滞剂可降低CSPH患者的发病率和死亡率。不幸的是，它们仍然是CSPH唯一获批的治疗方法，且并非对所有患者都能有效降低门静脉压力，这凸显了迫切需要更多治疗选择以及评估治疗反应的实用方法。最近的创新和正在进行的研究正引领该领域朝着更个性化的方法发展，即根据个体患者的风险概况进行诊断、治疗和随访。这一进展有可能改善CSPH患者的治疗效果。
