Christian Sebesta, Mathias Jachs, Lukas Hartl, Michael Schwarz, Lorenz Balcar, Benedikt S. Hofer, Nina Dominik, Georg Kramer, Bernhard Scheiner, Albert F. Stättermayer, Benedikt Simbrunner, Till Schöchtner, Friedrich Haimberger, Nicolas Balutsch, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, David J. M. Bauer
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We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>While patients with alcohol-related liver disease (ALD; <i>n</i> = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction–associated steatohepatitis (MASH; <i>n</i> = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; <i>p</i> = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. 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引用次数: 0
摘要
肝刚度测量（LSM）和脾刚度测量（SSM）是门脉高压（PH）的无创替代品，两者都与肝静脉压梯度（HVPG）相关。SSM可以克服HVPG和LSM在检测窦前PH成分方面的局限性。我们研究了SSM/LSM比率作为PH的替代指标，以及它与不同肝病病因的HVPG和脾脏直径的关系。方法对连续399例代偿性肝病患者进行当日HVPG、LSM和SSM测定。结果酒精相关性肝病（ALD, n = 200）患者的LSM（中位数：45.5 kPa）和HVPG （15.0 mmHg）高于代谢功能障碍相关脂肪性肝炎（MASH, n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg），但两者的SSM（中位数：58.8 vs. 52.8 kPa; p = 0.868）无显著差异。因此，MASH患者的SSM/LSM比率（1.66）高于ALD患者（1.28），但非肝硬化PH患者的SSM/LSM比率最高（3.19）。当调整HVPG时，在任何给定的HVPG下，MASH的SSM和脾直径仍然明显高于ALD。结论：本研究表明，SSM/LSM比率在不同的肝脏疾病病因中存在差异。由于MASH患者-在调整肝病严重程度后-显示出比ALD更高的SSM/LSM比率和更大的脾脏直径，我们的研究结果支持了MASH患者中PH的窦前成分的概念。
Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH—A Prospective, Comparative Study
Background
Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.
Methods
399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.
Results
While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction–associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.
Conclusions
This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients—after adjusting for liver disease severity—show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.
期刊介绍：
Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.
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