Spleen stiffness to liver stiffness ratio significantly differs between ALD and HCV and predicts disease-specific complications

被引：15

作者：

Elshaarawy, Omar ^{[1
,2
]}

Mueller, Johannes ^{[1
,2
]}

Guha, Indra Neil ^{[3
,4
]}

Chalmers, Jane ^{[3
,4
]}

Harris, Rebecca ^{[3
,4
]}

Krag, Aleksander ^{[5
,6
]}

Madsen, Bjorn Staehr ^{[5
,6
]}

Stefanescu, Horia ^{[7
,8
]}

Farcau, Oana ^{[7
,8
]}

Ardelean, Andreea ^{[7
,8
]}

Procopet, Bogdan ^{[7
,8
]}

Thiele, Maja ^{[5
,6
]}

Mueller, Sebastian ^{[1
,2
]}

机构：

[1] Heidelberg Univ, Salem Med Ctr, Dept Med, Zeppelinstr 11-33, D-69121 Heidelberg, Germany

[2] Heidelberg Univ, Ctr Alcohol Res, Salem Med Ctr, Zeppelinstr 11-33, D-69121 Heidelberg, Germany

[3] Nottingham Univ Hosp NHS Trust, NIHR Nottingham Biomed Res Ctr, Nottingham, England

[4] Univ Nottingham, Nottingham, England

[5] Odense Univ Hosp, Dept Gastroenterol & Hepatol, OPEN, Odense, Denmark

[6] Odense Univ Hosp, Odense Patient Data Exploratory Network, OPEN, Odense, Denmark

[7] Reg Inst Gastroenterol & Hepatol, Dept Hepatol, Cluj Napoca, Romania

[8] Reg Inst Gastroenterol & Hepatol, Liver Res Club, Cluj Napoca, Romania

来源：

JHEP REPORTS | 2019年 / 1卷 / 02期

关键词：

Cirrhosis; liver decompensation; alcohol detoxification; DAAs; portal hypertension;

D O I：

10.1016/j.jhepr.2019.05.003

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background & Aims: Both liver stiffness (LS) and spleen stiffness (SS) are widely used to non-invasively assess liver fibrosis and portal hypertension, respectively. We aimed to identify the impact of disease etiology, namely the localization of inflammation (portal vs. lobular), on the SS/LS ratio. Methods: In this multicenter study, LS and SS were prospectively assessed in 411 patients with alcohol-related liver disease (ALD) or hepatitis C virus (HCV) using FibroScan (R) (Echosens, Paris); changes in these parameters were also studied in response to treatment (alcohol withdrawal, HCV therapy). LS and spleen length (SL) were further analyzed in a retrospective cohort of 449 patients with long-term data on decompensation/death. Results: Both, SS and SL were significantly higher in HCV compared to ALD (42.0 vs. 32.6 kPa, p<0.0001, 15.6 vs. 11.9 cm, p<0.0001) despite a lower mean LS in HCV. Consequently, the SS to LS ratio and the SL to LS ratio were significantly higher in HCV (3.8 vs. 1.72 and 1.46 vs. 0.86, p<0.0001) through all fibrosis stages. Notably, SL linearly increased with SS and the relation between SS and SL was identical in HCV and ALD. In contrast, livers were much larger in ALD at comparable LS. After treatment, LS significantly decreased in both diseases without significant changes to the SS/LS ratio. In the prognostic cohort, patients with ALD had higher LS values (30.5 vs. 21.3 kPa) and predominantly presented with jaundice (65.2%); liver failure was the major cause of death (p<0.01). In contrast, in HCV, spleens were larger (17.6 vs. 12.1 cm) while variceal bleeding was the major cause of decompensation (73.2%) and death (p<0.001). Conclusion: Both SS/LS and SL/LS ratios are significantly higher in patients with portal HCV compared to lobular ALD. Thus, combined LS and SS or SL measurements provide additional information about disease etiology and disease-specific complications. Crown Copyright (c) 2019 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：99 / 106

页数：8

共 37 条

[1] Addition of Simvastatin to Standard Therapy for the Prevention of Variceal Rebleeding Does Not Reduce Rebleeding but Increases Survival in Patients With Cirrhosis [J].