Sebesta Christian, Jachs Mathias, Hartl Lukas, Schwarz Michael, Balcar Lorenz, Hofer Benedikt S, Dominik Nina, Kramer Georg, Scheiner Bernhard, Stättermayer Albert F, Simbrunner Benedikt, Schöchtner Till, Haimberger Friedrich, Balutsch Nicolas, Trauner Michael, Mandorfer Mattias, Reiberger Thomas, Bauer David J M
Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Liver Int. 2025 Oct;45(10):e70261. doi: 10.1111/liv.70261.
BACKGROUND: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies. METHODS: 399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included. RESULTS: While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction-associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG. CONCLUSIONS: This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients-after adjusting for liver disease severity-show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.
背景：肝脏硬度测量（LSM）和脾脏硬度测量（SSM）是门静脉高压（PH）的非侵入性替代指标，两者均与肝静脉压力梯度（HVPG）相关。SSM可能克服HVPG和LSM在检测窦前性PH成分方面的局限性。我们研究了SSM/LSM比值作为PH替代指标及其与不同肝病病因的HVPG和脾脏直径的关系。 方法：前瞻性纳入399例同日接受HVPG、LSM和SSM测量的代偿期肝病患者。 结果：与代谢功能障碍相关脂肪性肝炎（MASH；n = 49；LSM：20.9 kPa；HVPG：12.0 mmHg）患者相比，酒精性肝病（ALD；n = 200）患者的LSM（中位数：45.5 kPa）和HVPG（15.0 mmHg）更高，但其SSM（中位数：58.8 vs. 52.8 kPa；p = 0.868）无显著差异。因此，MASH患者的SSM/LSM比值（1.66）高于ALD患者（1.28），但在非肝硬化性PH患者中最高（3.19）。在校正HVPG后，在任何给定的HVPG水平下，MASH患者的SSM和脾脏直径仍显著高于ALD患者。 结论：本研究表明，SSM/LSM比值在不同肝病病因中有所不同。由于在调整肝病严重程度后，MASH患者的SSM/LSM比值和脾脏直径高于ALD患者，我们的结果支持MASH患者存在窦前性PH成分的概念。
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