Invasive and non-invasive techniques for detecting portal hypertension and predicting variceal bleeding in cirrhosis: a review.
Invasive and non-invasive techniques for detecting portal hypertension and predicting variceal bleeding in cirrhosis: a review.
复制标题
DOI：
10.3109/07853890.2013.857831
复制
发表时间：
2014-02
影响因子：
4.4
通讯作者：
Sanyal AJ
中科院分区：
文献类型：
--
作者：
Zardi EM;Di Matteo FM;Pacella CM;Sanyal AJ
门静脉高压症是一种严重的综合征，可能源于前窦，窦和后窦的原因。因此，一些并发症（即，腹水、食管静脉曲张）。肝静脉压力梯度（HVPG）是一种可靠的方法，用于确定门静脉压力的等级，建立治疗的有效性和预测并发症的发生;然而，存在一些问题，其区分出血和非出血性静脉曲张的能力在肝硬化患者。其他成像技术（瞬时弹性成像，内窥镜检查，超声内镜检查和多普勒超声检查）评估门静脉高压综合征的原因和并发症是可用的，可能是有价值的管理这些患者。在这篇综述中，我们评估了目前用于获得致命并发症的临床预测的侵入性和非侵入性技术，例如受窦状门静脉高压症影响的患者的静脉曲张出血，以创建一个诊断算法来管理它们。同样，HVPG似乎是评价门静脉高压和监测治疗反应的参考标准，但其预测几种并发症和支持管理决策的能力可能会进一步提高，通过与其他成像技术的诊断组合。
Portal hypertension is a severe syndrome that may derive from pre-sinusoidal, sinusoidal and post-sinusoidal causes. As a consequence, several complications (i.e., ascites, oesophageal varices) may develop. In sinusoidal portal hypertension, hepatic venous pressure gradient (HVPG) is a reliable method for defining the grade of portal pressure, establishing the effectiveness of the treatment and predicting the occurrence of complications; however, some questions exist regarding its ability to discriminate bleeding from nonbleeding varices in cirrhotic patients. Other imaging techniques (transient elastography, endoscopy, endosonography and duplex Doppler sonography) for assessing causes and complications of portal hypertensive syndrome are available and may be valuable for the management of these patients. In this review, we evaluate invasive and non-invasive techniques currently employed to obtain a clinical prediction of deadly complications, such as variceal bleeding in patients affected by sinusoidal portal hypertension, in order to create a diagnostic algorithm to manage them. Again, HVPG appears to be the reference standard to evaluate portal hypertension and monitor the response to treatment, but its ability to predict several complications and support management decisions might be further improved through the diagnostic combination with other imaging techniques.