切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (03) : 270 -275. doi: 10.3877/cma.j.issn.2095-3232.2024.03.004

所属专题: 述评 综述

专家论坛

肝硬化门静脉高压症门静脉压力无创测量进展
刘起帆1, 蒋安1,()   
  1. 1. 710004 西安交通大学第二附属医院移植外科
  • 收稿日期:2024-01-24 出版日期:2024-06-10
  • 通信作者: 蒋安
  • 基金资助:
    陕西省重点研发计划项目(2022SF-372)

Progress in non-invasive measurement of portal vein pressure in cirrhotic portal hypertension

Qifan Liu1, An Jiang1,()   

  1. 1. Department of Transplantation Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
  • Received:2024-01-24 Published:2024-06-10
  • Corresponding author: An Jiang
引用本文:

刘起帆, 蒋安. 肝硬化门静脉高压症门静脉压力无创测量进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 270-275.

Qifan Liu, An Jiang. Progress in non-invasive measurement of portal vein pressure in cirrhotic portal hypertension[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 270-275.

食管静脉曲张破裂出血作为肝硬化门静脉高压症最常见、凶险的并发症,时刻威胁患者的生命健康。准确评估门静脉压力为肝硬化患者预防疾病发展、监测并发症、选择治疗策略以及评估预后等提供重要依据。目前肝静脉压力梯度(HVPG)仍是诊断门静脉高压症的金标准,但此检查为有创操作,局限性及操作风险较大。近年来无创测量门静脉的方法取得较多进展。本文将对门静脉压力无创性检测方法及应用前景进行阐述和介绍。

Esophageal variceal bleeding, as the most common and severe complication of liver cirrhosis and portal hypertension, persistenly threatens the life and health of patients. Accurate evaluation of portal vein pressure provides valuable evidence for preventing disease progression, monitoring complications, choosing treatment strategies and evaluating clinical prognosis in patients with liver cirrhosis. At present, the hepatic venous pressure gradient (HVPG) remains the gold standard for the diagnosis of portal hypertension, whereas it is an invasive procedure with limitations and surgical risks. In recent years, certain progress has been made in non-invasive measurement of portal vein pressure. In this article, non-invasive detection method of portal vein pressure and its application prospect were illustrated.

图1 脾-肝指数放射性核素检测[7]注:a为前视图,红线为最长肝长度;b为前视图,右肝叶中心25像素感兴趣区域的平均肝数(红方);c为矢状面,脾中心25像素感兴趣区域(蓝色方块)的平均脾计数
[1]
International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia[J]. Hepatology, 2009, 49(2):658-664.
[2]
Reiniš J, Petrenko O, Simbrunner B, et al. Assessment of portal hypertension severity using machine learning models in patients with compensated cirrhosis[J]. J Hepatol, 2023, 78(2):390-400.
[3]
Ni JY, Fang ZT, Sun HL, et al. A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation[J]. Eur Radiol, 2020, 30(4):2377-2390.
[4]
陈超,吴茜茜,黄尔炯, 等. 门静脉压力测定的常用方法与前景[J]. 中华消化内镜杂志, 2022, 39(5):361-366.
[5]
Tornai T, Vitalis Z, Sipeki N, et al. Macrophage activation marker, soluble CD163, is an independent predictor of short-term mortality in patients with cirrhosis and bacterial infection[J]. Liver Int, 2016, 36(11):1628-1638.
[6]
Grønbaek 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.
[7]
Kim T, Kim BW, Wang HJ, et al. Quantitative assessment of the portal pressure for the liver surgery using serological tests[J]. Ann Surg, 2016, 264(2):330-338.
[8]
邓昌林,张书平,黄超红, 等. 肝硬化门脉高压术后肝功能不全的危险因素分析[J]. 解放军医学杂志, 2018, 43(9):795-798.
[9]
叶晓航,张荣荣,陶晶. ARFI联合血清学指标对慢性乙型肝炎患者肝纤维化和门静脉压力评估的临床研究[J]. 肝脏, 2020, 25(12):1300-1302.
[10]
Dercle L, Billey C, Cognet T, et al. Spleno-hepatic index to predict portal hypertension by equilibrium radionuclide ventriculography[J]. Nucl Med Commun, 2018, 39(12):1138-1142.
[11]
陈曦,李志艳,李志伟. 彩色多普勒超声检查在门静脉高压症中的应用价值[J]. 中国医刊, 2019, 54(2):141-144.
[12]
Kondo T, Maruyama H, Sekimoto T, et al. Impact of portal hemodynamics on Doppler ultrasonography for predicting decompensation and long-term outcomes in patients with cirrhosis[J]. Scand J Gastroenterol, 2016, 51(2):236-244.
[13]
Shahed FHM, Mamun-Al-Mahtab, Rahman S. The evaluation of serum ascites albumin gradient and portal hypertensive changes in cirrhotic patients with ascites[J]. Euroasian J Hepatogastroenterol, 2016, 6(1):8-9.
[14]
Puente Á, Cabezas J, López Arias MJ, et al. Influence of sustained viral response on the regression of fibrosis and portal hypertension in cirrhotic HCV patients treated with antiviral triple therapy[J]. Rev Esp Enferm Dig, 2017, 109(1):17-25.
[15]
Yao H, Wang Y. Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension[J]. Open Life Sci, 2020, 15(1):981-987.
[16]
刘家成,周晨,石钦, 等. 临床显著性门静脉高压无创预测[J]. 介入放射学杂志, 2020, 29(5):521-526.
[17]
Nanashima A, Abo T, Arai J, et al. Prediction of portal pressure from intraoperative ultrasonography[J]. J Surg Res, 2014, 192(2):395-401.
[18]
Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1):310-335.
[19]
孙洪程,徐洪雨. 门静脉压力评估方法的现状及研究进展[J]. 医学综述, 2021, 27(3):534-539.
[20]
张晓丰,何钦俊,王海玉, 等. 《Baveno Ⅶ门静脉高压共识更新:门静脉高压的个体化管理》摘译[J]. 临床肝胆病杂志, 2022, 38(6):1258-1268.
[21]
Hong WK, Kim MY, Baik SK, et al. The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data[J]. Clin Mol Hepatol, 2013, 19(4):370-375.
[22]
Zykus R, Jonaitis L, Petrenkienė V, et al. Erratum to: liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study[J]. BMC Gastroenterol, 2016, 16(1):53.
[23]
Castéra L, García-Tsao G. When the spleen gets tough, the varices get going[J]. Gastroenterology, 2013, 144(1):19-22.
[24]
Tseng Y, Li F, Wang J, et al. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices[J]. J Clin Ultrasound, 2018, 46(7):442-449.
[25]
Takuma Y, Nouso K, Morimoto Y, et al. Portal hypertension in patients with liver cirrhosis: diagnostic accuracy of spleen stiffness[J]. Radiology, 2016, 279(2):609-619.
[26]
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.
[27]
Jansen C, Bogs C, Verlinden W, et al. Algorithm to rule out clinically significant portal hypertension combining shear-wave elastography of liver and spleen: a prospective multicentre study[J]. Gut, 2016, 65(6):1057-1058.
[28]
Madhusudhan KS, Kilambi R, Shalimar, et al. Evaluation of splenic stiffness in patients of extrahepatic portal vein obstruction using 2D shear wave elastography: comparison with intra-operative portal pressure[J]. J Clin Exp Hepatol, 2018, 8(3):250-255.
[29]
Nakagomi R, Tateishi R, Masuzaki R, et al. Liver stiffness measurements in chronic hepatitis C: treatment evaluation and risk assessment[J]. J Gastroenterol Hepatol, 2019, 34(5):921-928.
[30]
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.
[31]
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.
[32]
Qi X, An W, Liu F, et al. Virtual hepatic venous pressure gradient with CT angiography (CHESS 1601):a prospective multicenter study for the noninvasive diagnosis of portal hypertension[J]. Radiology, 2019, 290(2):370-377.
[33]
王剑,时培美,沈杰, 等. 基于多层螺旋CT评估肝硬化门静脉高压症的无创诊断模型[J]. 肝脏, 2021, 26(11):1240-1245.
[34]
刘伟,刘盛楠. 门静脉造影+多层螺旋CT用于肝硬化食管胃底静脉曲张破裂出血患者围术期的意义[J]. 肝脏, 2020, 25(11):1185-1187.
[35]
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.
[36]
Venkatesh SK, Ehman RL. Magnetic resonance elastography of abdomen[J]. Abdom Imaging, 2015, 40(4):745-759.
[37]
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, 2017:2067479.
[38]
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.
[1] 贺健, 张骊, 王洪海, 蒋文涛. 肝移植术后脾功能亢进转归及治疗研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 310-314.
[2] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[3] 吴俊嶺, 孟科, 刘江涛, 孙刚. 基于HVPG分层的门脉高压内镜治疗中远期疗效研究[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(02): 100-105.
[4] 蔡艺丹, 方坚, 张志强, 陈莉, 张世安, 夏磊, 阮梅, 李东良. 经颈静脉肝内门体分流术对肝硬化门脉高压患者肠道菌群及肝功能的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 285-293.
[5] 邓万玉, 陈富, 许磊波. 肝硬化与非肝硬化乙肝相关性肝癌患者术后无复发生存比较及其影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 670-674.
[6] 杨竞, 周光文. 肝硬化门静脉高压症治疗后再出血危险因素分析及预测模型构建[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 296-301.
[7] 张宇, 余灵祥, 赵亮, 张宁, 赵德希, 刁广浩, 杨木易, 刘佳, 李鹏, 任辉. 利伐沙班在脾切除联合贲门周围血管离断术后门静脉血栓预防中的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 195-199.
[8] 苏日顺, 卢逸, 庄宝鼎, 张译, 李彦杰, 徐见亮. 肝硬化脾亢脾切除术后门静脉血栓形成影响因素[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 39-44.
[9] 沈佳佳, 何经雄, 王芳, 江艺, 潘凡, 张小进. ICG荧光引导腹腔镜射频消融在合并严重大结节肝硬化小肝癌患者治疗中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 68-71.
[10] 崔健, 夏青, 林云, 李光玲, 李心娜, 王位. 血小板与淋巴细胞比值、免疫球蛋白、心肌酶谱及心电图对中老年肝硬化患者病情及预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 400-406.
[11] 秦相清, 朱陈, 张海银. 构建诺模图模型预测肝硬化食管胃底静脉曲张出血的风险[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 330-335.
[12] 刘燚隆, 党荣广, 艾蓉, 张凯. 肝硬化合并静脉曲张出血患者内镜治疗后再出血风险的模型建立与验证[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(04): 336-342.
[13] 戚泽雪, 赵连晖, 王广川, 张春清. 从国内专家共识推荐意见更新探讨经颈静脉肝内门体分流术的临床应用进展[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 193-196.
[14] 王秀, 王义国. 益生菌联合恩替卡韦治疗乙型肝炎肝硬化临床疗效的meta分析[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(02): 164-171.
[15] 邸文佳, 牛爱原. 基于东亚人群的肝硬化与骨质疏松症相关性研究[J/OL]. 中华老年病研究电子杂志, 2024, 11(01): 40-44.
阅读次数
全文


摘要