門靜脈高壓相關并發癥是進展型慢性肝病患者死亡的主要原因。肝靜脈壓力梯度為評估門靜脈高壓的金標準,上消化道內鏡檢查是篩查和評估食管胃靜脈曲張及嚴重程度的重要手段;兩者均為侵入性操作,不便于門靜脈高壓的篩查和監測。
基于振動控制瞬時彈性成像的肝臟硬度和脾臟硬度檢測的無創方法,可用于進展型慢性肝病患者的門靜脈高壓,尤其是臨床顯著性門靜脈高壓的篩查、分層診斷和監測。
在近期落幕的“第二屆大灣區肝病國際高峰論壇暨2023國際消除病毒性肝炎大會”之中法肝病論壇上,南方醫科大學南方醫院陳金軍教授分享了“肝脾硬度在慢性肝病全病程無創管理中的應用”,愛科森學院將精彩內容整理成文,以饗讀者。
概述
關注cACLD:門靜脈高壓管理的重點人群
知識盲點
根據最新的BAVENO VII共識[5],cACLD是指通過肝硬度值(LSM)反映的持續進展的CLD患者由嚴重肝纖維化演變為肝硬化的連續過程。由于cACLD的概念更加關注CLD患者發生臨床顯著性門靜脈高壓(Clinical Significant Portal Hypertension, CSPH)和失代償的風險,且由簡單、快捷的LSM檢測為患者進行風險分層(不考慮組織學分期或LSM識別這些分期的能力),因此,臨床上相較于傳統常用的“代償期肝硬化”概念, cACLD的概念更為實用。
01
cACLD患者的管理
02
門靜脈高壓病程的管理
關注CSPH:無創篩查策略
01
SSM在CSPH和食管靜脈曲張評估中的臨床價值
02
肝脾聯合技術在CSPH和食管靜脈曲張評估中的應用價值
小結
參考文獻
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2.?D'Amico, G et al. “Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients.” Alimentary pharmacology & therapeutics vol. 39,10 (2014): 1180-93
3.?D'Amico, Gennaro et al. “Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.” Journal of hepatology vol. 44,1 (2006): 217-31?
4.?張曉豐, 陳金軍. 肝硬化門靜脈高壓的無創篩查管理[J]. 臨床肝膽病雜志, 2022, 38(6):4
5.?de Franchis, Roberto et al. “Baveno VII - Renewing consensus in portal hypertension.” Journal of hepatology vol. 76,4 (2022): 959-974
6. Papatheodoridi, Margarita et al. “Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease.” Journal of hepatology vol. 74,5 (2021): 1109-1116?
7.?Ji, Yali et al. “Baveno VI elastography criteria for ruling in cACLD works well in patients with MAFLD.” Journal of hepatology vol. 75,5 (2021): 1243-1245
8.?Pons, Monica et al. “Noninvasive Diagnosis of Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease.” The American journal of gastroenterology vol. 116,4 (2021): 723-732
9.?Garcia-Tsao, Guadalupe 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.” Hepatology (Baltimore, Md.) vol. 65,1 (2017): 310-335
10.?Colecchia, Antonio et al. “Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis.” Gastroenterology vol. 143,3 (2012): 646-654?
11.?Colecchia, Antonio et al. “A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease.” Journal of hepatology vol. 69,2 (2018): 308-317?
12.?Wang, Haiyu et al. “Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis.” Journal of hepatology vol. 74,3 (2021): 584-592
13.?Zhang, Xiaofeng et al. “Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis.” Journal of hepatology vol. 78,3 (2023): 574-583
14.?Dajti, Elton et al. “A Combined Baveno VII and Spleen Stiffness Algorithm to Improve the Noninvasive Diagnosis of Clinically Significant Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease.” The American journal of gastroenterology vol. 117,11 (2022): 1825-1833
專家簡介
感染內科(肝病中心)副主任兼增城分院肝病科主任,主任醫師、教授,博士研究生導師;博士后合作導師。目前負責南方醫院感染(肝?。W科的肝臟中心病區、脂肪肝亞???、南方醫院增城分院肝病科。臨床擅長處置肝衰竭及復雜肝硬化的管理,脂肪性肝病、酒精性肝病及疑難肝病的診治。
學術任職:廣東省精準醫學應用學會肝病分會副主任委員兼秘書、廣東省感染醫師協會副主任委員、廣東省醫學會感染病分會委員兼秘書等。研究主要關注終末期肝病,包括門靜脈高壓、凝血障礙等,獲得三項國家自然科學基金資助,牽頭主持科技部重大專項課題一項。近5年發表SCI論文10余篇。與駱抗先教授共同編著《乙型肝炎.基礎與臨床》第四版。