门静脉高压无创评估方法的研究进展

周昊; 杨建江; 汤善宏; 冯志松; 秦建平

doi:10.3969/j.issn.1001-5256.2018.08.043

门静脉高压无创评估方法的研究进展

DOI: 10.3969/j.issn.1001-5256.2018.08.043

1. 川北医学院
2. 九里梗77110部队
3. 成都军区总医院消化内科
4. 川北医学院附属医院消化内科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 1595
- HTML全文浏览量: 47
- PDF下载量: 365
- 被引次数: 0
出版历程
- 收稿日期: 2018-02-13
- 出版日期: 2018-08-20

Research advances in noninvasive assessment of portal hypertension

North Sichuan Medical College

摘要

摘要: 肝硬化失代偿期患者存在不同程度门静脉高压,当门静脉压力达到一定程度,将出现各种严重的临床并发症,威胁患者生命,因此门静脉压力的评估对此类患者的临床管理及预后至关重要。由于门静脉独特的解剖学特点,直接测量门静脉压力比较困难,目前国内外普遍用肝静脉压力梯度值来替代门静脉压力值,但肝静脉压力梯度测定属于介入方法,也难以在临床常规开展。因此,门静脉高压无创评估成为目前研究热点。本文旨在对血清标志物、超声弹性成像、CT、MRI/磁共振弹性成像在门静脉高压无创评估中的研究进展作一综述。
- 肝硬化 /
- 高血压,门静脉 /
- 诊断 /
- 综述
Abstract: Patients with decompensated cirrhosis often have varying degrees of portal hypertension, and when portal pressure reaches a certain threshold, various clinical complications may occur and even threaten patients' lives. Therefore, portal pressure assessment is important for the clinical management and prognosis of such patients. Due to the anatomical characteristics of the portal vein, it is difficult to measure portal pressure directly. At present, hepatic venous pressure gradient is used to replace portal pressure in China and foreign countries. However, the measurement of hepatic venous pressure gradient is an interventional procedure and is difficult to perform in clinical practice.Therefore, noninvasive assessment of portal hypertension has become a research hotspot. This article reviews the research advances in the roles of serum markers, ultrasound elastography, computed tomography, and magnetic resonance imaging/magnetic resonance elastography in noninvasive assessment of portal hypertension.
- liver cirrhosis /
- hypertension, portal /
- diagnosis /
- review

HTML全文

参考文献(48)

[1]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :203-219. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-219.

[2]BOSCH J, IWAKIRI Y.The portal hypertension syndrome:Etiology, classification, relevance, and animal models[J].Hepatol Int, 2018, 12 (Suppl 1) :1-10.

[3]TANG SH, QIN JP, JIANG MD, et al.Application of hepatic venous pressure gradient in portal hypertension-related diseases[J].Chin J Hepatol, 2014, 22 (7) :555-557. (in Chinese) 汤善宏, 秦建平, 蒋明德, 等.肝静脉压力梯度在门静脉高压相关疾病中应用的研究进展[J].中华肝脏病杂志, 2014, 22 (7) :555-557.

[4]TANG SH, QIN JP, JIANG MD, et al.The agreement and clinical value of hepatic vein pressure gradient and portal vein pressure in patients with portal hypertension[J].Chin J Hepatol, 2015, 23 (5) :354-357. (in Chinese) 汤善宏, 秦建平, 蒋明德, 等.门静脉高压患者肝静脉压力梯度与门静脉压相关性及其临床价值[J].中华肝脏病杂志, 2015, 23 (5) :354-357.

[5]WANG L, FENG Y, MA X, et al.Diagnostic efficacy of noninvasive liver fibrosis indexes in predicting portal hypertension in patients with cirrhosis[J].PLo S One, 2017, 12 (8) :e182969.

[6]KROPF J, GRESSNER AM, TITTOR W.Logistic-regression model for assessing portal hypertension by measuring hyaluronic acid (hyaluronan) and laminin in serum[J].Clin Chem, 1991, 37 (1) :30-35.

[7]KORNER T, KROPF J, GRESSNER AM.Serum laminin and hyaluronan in liver cirrhosis:Markers of progression with high prognostic value[J].J Hepatol, 1996, 25 (5) :684-688.

[8]BARANOVA A, LAL P, BIRERDINC A, et al.Non-invasive markers for hepatic fibrosis[J].BMC Gastroenterol, 2011, 11:91.

[9]JANSEN C, LEEMING DJ, MANDORFER M, et al.PRO-C3-levels in patients with HIV/HCV-Co-infection reflect fibrosis stage and degree of portal hypertension[J].PLo S One, 2014, 9 (9) :e108544.

[10]LEEMING DJ, KARSDAL MA, BYRJALSEN I, et al.Novel serological neo-epitope markers of extracellular matrix proteins for the detection of portal hypertension[J].Aliment Pharmacol Ther, 2013, 38 (9) :1086-1096.

[11]van MOURIK JA, BOERTJES R, HUISVELD IA, et al.von Willebrand factor propeptide in vascular disorders:A tool to distinguish between acute and chronic endothelial cell perturbation[J].Blood, 1999, 94 (1) :179-185.

[12]LISMAN T, LEEBEEK FW, de GROOT PG.Haemostatic abnormalities in patients with liver disease[J].J Hepatol, 2002, 37 (2) :280-287.

[13]La MURA V, REVERTER JC, FLORES-ARROYO A, et al.von Willebrand factor levels predict clinical outcome in patients with cirrhosis and portal hypertension[J].Gut, 2011, 60 (8) :1133-1138.

[14]FERLITSCH M, REIBERGER T, HOKE M, et al.von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis[J].Hepatology, 2012, 56 (4) :1439-1447.

[15]KAZANKOV K, BARRERA F, MOLLER HJ, et al.Soluble CD163, a macrophage activation marker, is independently associated with fibrosis in patients with chronic viral hepatitis B and C[J].Hepatology, 2014, 60 (2) :521-530.

[16]GRONBAEK H, SANDAHL TD, MORTENSEN C, et al.Soluble CD163, a marker of Kupffer cell activation, is related to portal hypertension in patients with liver cirrhosis[J].Aliment Pharmacol Ther, 2012, 36 (2) :173-180.

[17]WAIDMANN O, BRUNNER F, HERRMANN E, et al.Macrophage activation is a prognostic parameter for variceal bleeding and overall survival in patients with liver cirrhosis[J].J Hepatol, 2013, 58 (5) :956-961.

[18]BERZIGOTTI A, PISCAGLIA F.Ultrasound in portal hypertension─part 1[J].Ultraschall Med, 2011, 32 (6) :548-568, 569-571.

[19]BERZIGOTTI A, PISCAGLIA F.Ultrasound in portal hypertension─part 2─and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension[J].Ultraschall Med, 2012, 33 (1) :8-32, 30-31.

[20]SANDRIN L, FOURQUET B, HASQUENOPH JM, et al.Transient elastography:A new noninvasive method for assessment of hepatic fibrosis[J].Ultrasound Med Biol, 2003, 29 (12) :1705-1713.

[21]CARRION JA, NAVASA M, BOSCH J, et al.Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation[J].Liver Transpl, 2006, 12 (12) :1791-1798.

[22]de FRANCHIS R.Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.

[23]ZYKUS R, JONAITIS L, PETRENKIENE·V, et al.Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease:A prospective cohort study[J].BMC Gastroenterol, 2015, 15:183.

[24]COLECCHIA A, MONTRONE L, SCAIOLI E, et al.Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis[J].Gastroenterology, 2012, 143 (3) :646-654.

[25]爦IRLI R.Ultrasound-based elastography for the diagnosis of portal hypertension in cirrhotics[J].World J Gastroenterol, 2015, 21 (41) :11542.

[26]SALZL P, REIBERGER T, FERLITSCH M, et al.Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J].Ultraschall Med, 2014, 35 (6) :528-533.

[27]ATTIA D, SCHOENEMEIER B, RODT T, et al.Evaluation of liver and spleen stiffness with acoustic radiation force impulse quantification elastography for diagnosing clinically significant portal hypertension[J].Ultraschall Med, 2015, 36 (6) :603-610.

[28]RIFAI K, CORNBERG J, BAHR M, et al.ARFI elastography of the spleen is inferior to liver elastography for the detection of portal hypertension[J].Ultraschall Med, 2011, 32 (Suppl 2) :e24-e30.

[29]CHOI SY, JEONG WK, KIM Y, et al.Shear-wave elastography:A noninvasive tool for monitoring changing hepatic venous pressure gradients in patients with cirrhosis[J].Radiology, 2014, 273 (3) :917-926.

[30]KIM TY, JEONG WK, SOHN JH, et al.Evaluation of portal hypertension by real-time shear wave elastography in cirrhotic patients[J].Liver Int, 2015, 35 (11) :2416-2424.

[31]MARUYAMA H, KOBAYASHI K, KIYONO S, et al.Two-dimensional shear wave elastography with propagation-based reliability assessment for grading hepatic fibrosis and portal hypertension[J].J Hepato-Bil-Pan Sci, 2016, 23 (9) :595-602.

[32]PROCOPET B, BERZIGOTTI A, ABRALDES JG, et al.Realtime shear-wave elastography:Applicability, reliability and accuracy for clinically significant portal hypertension[J].J Hepatol, 2015, 62 (5) :1068-1075.

[33]ROCCARINA D, ROSSELLI M, GENESCA J, et al.Elastography methods for the non-invasive assessment of portal hypertension[J].Expert Rev Gastroenterol Hepatol, 2018, 12 (2) :155-164.

[34]IRANMANESH P, VAZQUEZ O, TERRAZ S, et al.Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma[J].J Hepatol, 2014, 60 (5) :969-974.

[35]QI X, LIU F, LI Z, et al.Insufficient accuracy of computed tomography-based portal pressure assessment in hepatitis B virus-related cirrhosis:An analysis of data from CHESS-1601 trial[J].J Hepatol, 2018, 68 (1) :210-211.

[36]QI X, LI Z, HUANG J, et al.Virtual portal pressure gradient from anatomic CT angiography[J].Gut, 2015, 64 (6) :1004-1005.

[37]LEE JY, KIM TY, JEONG WK, et al.Clinically severe portal hypertension:Role of multi-detector row ct features in diagnosis[J].Dig Dis Sci, 2014, 59 (9) :2333-2343.

[38]TALAKIC'E, SCHAFFELLNER S, KNIEPEISS D, et al.CT perfusion imaging of the liver and the spleen in patients with cirrhosis:Is there a correlation between perfusion and portal venous hypertension?[J].Eur Radiol, 2017, 27 (10) :4173-4180.

[39]VENKATESH SK, LOOMBA R.Non-invasive estimation of HVPG by combined structural and hemodynamic evaluation of portal hypertension using quantitative magnetic resonance imaging[J].J Hepatol, 2016, 65 (6) :1079-1080.

[40]AGUIRRE-REYES DF, SOTELO JA, ARAB JP, et al.Intrahepatic portal vein blood volume estimated by non-contrast magnetic resonance imaging for the assessment of portal hypertension[J].Magn Reson Imaging, 2015, 33 (8) :970-977.

[41]PALANIYAPPAN N, COX E, BRADLEY C, et al.Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging[J].J Hepatol, 2016, 65 (6) :1131-1139.

[42]ZHANG QW, WANG Y, WANG J, et al.A non-invasive magnetic resonance imaging-based model predicts portal venous pressure[J].J Dig Dis, 2016, 17 (3) :175-185.

[43]SINGH S, VENKATESH S, KEAVENY A, et al.Diagnostic accuracy of magnetic resonance elastography in liver transplant recipients:A pooled analysis[J].Ann Hepatol, 2016, 15 (3) :363-376.

[44]YIN M, KOLIPAKA A, WOODRUM DA, et al.Hepatic and splenic stiffness augmentation assessed with MR elastography in an in vivo porcine portal hypertension model[J].J Magn Reson Imaging, 2013, 38 (4) :809-815.

[45]NEDREDAL GI, YIN M, MCKENZIE T, et al.Portal hypertension correlates with splenic stiffness as measured with MR elastography[J].J Magn Reson Imaging, 2011, 34 (1) :79-87.

[46]GHARIB AM, HAN MAT, MEISSNER EG, et al.Magnetic resonance elastography shear wave velocity correlates with liver fibrosis and hepatic venous pressure gradient in adults with advanced liver disease[J].Biomed Res Int, 2017, 2017:2067479.

[47]HIRSCH S, GUO J, REITER R, et al.Towards compression-sensitive magnetic resonance elastography of the liver:Sensitivity of harmonic volumetric strain to portal hypertension[J].J Magn Reson Imaging, 2014, 39 (2) :298-306.

[48]RONOT M, LAMBERT S, ELKRIEF L, et al.Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis[J].Eur Radiol, 2014, 24 (6) :1394-1402.

施引文献

资源附件(0)

访问统计