肝硬化门静脉高压无创性检测方法的认识与评价

Noninvasive Assessment of Portal Hypertension in Patients with Liver Cirrhosis

门静脉高压是导致肝硬化患者出现严重并发症和死亡的主要原因之一。肝静脉压力梯度(HVPG)是评价门静脉高压及其严重程度最准确的方法,但因具有创伤性和不适性,故需特别关注肝硬化门静脉高压无创性检测方法。通过血液学指标、超声检查和CT以及胶囊内镜等无创性检查方法,可初步评估代偿期肝硬化患者是否存在食管胃底静脉曲张。上消化道内镜检查是确定食管胃底静脉曲张的金标准。通过上消化道内镜或超声内镜检测食管静脉曲张压力,可判断药物或分流手术降低重度食管静脉曲张压力的疗效。虽然这些无创性检测方法可有效地评估门静脉高压的严重状况,但对轻度门静脉高压评估能力有限,有待进一步完善和提高。

Portal hypertension is the main cause of complication and death in patients with liver cirrhosis. Although measurement of hepatic ＇venous pressure gradient （HVPG） is the most accurate method for evaluating the presence and severity of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for determining the presence of variees, yet the technique is invasive and uncomfortable for patients. Several noninvasive techniques have been used to screen the presence of e,~ophageal varices such as by biochemical parameters, ultrasound, abdominal CT scanning, video capsule endoscopy. The varieeal pressure can be evaluated by an endoscopic gauge or endoscopic ultrasound, which can reflect the degree of portal hypertension and help to determine the efficacy of drug therapy or porto-systemic shunt operation. Although these noninvasive methods can effectively identify the degree of severe portal hypertension, yet the capability of evaluating mild portal hypertension is quite limited. Methods for diagnosing mild portal hypertension need to be developed.