Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Esophageal Varices in Patients With HCV-Related Cirrhosis
Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Esophageal Varices in Patients With HCV-Related Cirrhosis
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DOI：
10.1053/j.gastro.2012.05.035
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发表时间：
2012-09-01
期刊：
影响因子：
29.4
通讯作者：
Festi, Davide
中科院分区：
文献类型：
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作者：
Colecchia, Antonio;Montrone, Lucia;Festi, Davide
背景与目的：肝静脉压力梯度（HVPG）是判断门脉高压（PH）程度的标准，也是肝硬化患者预后的重要因素；HVPG值与食管静脉曲张（EV）存在相关。然而，HVPG只能在专门的中心准确测定；需要无创方法来预测HVPG值和EV的存在。我们比较了瞬态弹性成像测量脾脏硬度（SS）与肝脏硬度（LS）和其他最近提出的无创测试的诊断性能。方法：我们测量了连续100例丙型肝炎病毒诱导的肝硬化患者的SS和LS。患者还通过纤维扫描、HVPG、食管胃十二指肠镜和肝活检进行评估。我们还分析了ls -脾脏直径与血小板比值评分和血小板计数与脾脏直径的比值。结果：SS和LS比其他无创参数更准确地识别EV和不同程度ph的患者，包括SS和LS的线性模型准确预测HVPG值（R-2 = 0.85）。使用bootstrap分析对结果进行内部验证。结论：SS测定可用于丙型肝炎病毒诱导的肝硬化患者PH的无创评估和监测以及EV的检测。
BACKGROUND & AIMS: The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests. METHODS: We measured SS and LS in 100 consecutive patients with hepatitis C virus-induced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LS-spleen diameter to platelet ratio score and platelet count to spleen diameter. RESULTS: SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values (R-2 = 0.85). The results were internally validated using bootstrap analysis. CONCLUSIONS: Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus-induced cirrhosis.