門靜脈高壓是肝硬化患者最嚴(yán)重的并發(fā)癥之一，預(yù)防和治療門靜脈高壓對改善患者預(yù)后至關(guān)重要。
在近期落幕的“第二屆大灣區(qū)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，首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院尤紅教授分享了“道阻且長，行則將至：門靜脈高壓的管理”，愛科森學(xué)院將精彩內(nèi)容整理成文，以饗讀者。
概述
門靜脈高壓的無創(chuàng)評估
01
血清學(xué)評估方法
02
影像學(xué)評估方法
門靜脈高壓的治療
去年于北京召開的亞太肝臟研究學(xué)會肝纖維化專題會（ APASL STC ?Beijing 2022）上，專家們對于門靜脈高壓逆轉(zhuǎn)的評價初步達(dá)成了共識。主要從三個角度來判斷門靜脈高壓的逆轉(zhuǎn)：1. HVPG的顯著下降；2. 食管靜脈曲張分期或者程度下降最少等于1期；3. 門靜脈高壓的并發(fā)癥得到顯著減少。如果三個標(biāo)準(zhǔn)達(dá)到其中一個，可以考慮為門靜脈高壓的逆轉(zhuǎn)。?
參考文獻
1.?Magaz, Marta et al. “Precision medicine in variceal bleeding: Are we there yet?.”?Journal of hepatology?vol. 72,4 (2020): 774-784
2.?Sutton, Harry et al. “Non-invasive Markers of Portal Hypertension: Appraisal of Adult Experience and Potential Utilisation in Children.”?Journal of pediatric gastroenterology and nutrition?vol. 66,4 (2018): 559-569
3.?Vuille-Lessard, élise et al. “Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease.”?Clinics in liver disease?vol. 25,2 (2021): 253-28
4.?Ferlitsch, Monika et al. “von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis.”?Hepatology (Baltimore, Md.)?vol. 56,4 (2012): 1439-47
5.Hametner, Stephanie et al. “The VITRO Score (Von Willebrand Factor Antigen/Thrombocyte Ratio) as a New Marker for Clinically Significant Portal Hypertension in Comparison to Other Non-Invasive Parameters of Fibrosis Including ELF Test.”?PloS one?vol. 11,2 e0149230. 19 Feb. 2016
6. Jachs, Mathias et al. “The Sequential Application of Baveno VII Criteria and VITRO Score Improves Diagnosis of Clinically Significant Portal Hypertension.”?Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, S1542-3565(22)00957-0. 14 Oct. 2022
7.?Vizzutti, Francesco et al. “Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis.”?Hepatology (Baltimore, Md.)?vol. 45,5 (2007): 1290-7
8.?Mandorfer, Mattias et al. “Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review.”?Seminars in liver disease?vol. 40,3 (2020): 240-255
9.?de Franchis, Roberto et al. “Baveno VII - Renewing consensus in portal hypertension.” Journal of hepatology vol. 76,4 (2022): 959-974
10.?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
11.?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
12.?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
專家簡介
尤紅，首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院黨委委員、副院長，主任醫(yī)師，研究員，教授，博士研究生導(dǎo)師。2009年入選教育部新世紀(jì)優(yōu)秀人才，2010年入選百千萬人才工程市級人選，2018年獲得北京市醫(yī)管局“登峰”人才培養(yǎng)計劃項目，享受國務(wù)院頒發(fā)的政府特殊津貼，2020年入選國家百千萬人才工程，授予“有突出貢獻青年專家”榮譽稱號。
致力于慢性乙肝肝纖維化臨床診治和纖維化發(fā)病機理研究。作為學(xué)科帶頭人，牽頭國家十二五、十三五重大傳染病科技專項。曾獲亞太地區(qū)肝病年會青年研究者獎、國家科技進步二等獎、2019年首都勞動獎?wù)隆?/p>
主要社會任職：中華醫(yī)學(xué)會肝病學(xué)分會 副主任委員，亞太肝病學(xué)會（APSAL）副秘書長，中華醫(yī)學(xué)會肝病學(xué)分會臨床流行病學(xué)與循證醫(yī)學(xué)協(xié)作組組長，中華醫(yī)學(xué)會肝病學(xué)分會纖維化學(xué)組副組長，中華醫(yī)學(xué)會肝病學(xué)分會自身免疫性肝病學(xué)組副組長，國際肝臟病理Laennec組織成員，Journal of Medical Virology 副主編，American Journal of Physiology-Gastrointestinal and Liver Physiology 編委。
