肖拉特突变,口服肖拉特挑战和门门高血压的内镜病变:SHUNT-V研究
Mitchell Shiffman1, K Rajender Reddy2, Michael D Leise3
1Bon Secours Liver Institute of Virginia, Richmond, Virginia, USA.
Alimentary pharmacology & therapeutics
|November 11, 2024
概括
疾病严重性指数 (DSI) 准确地识别了那些不需要内镜检查大食道静脉 (LEV) 的补偿性肝硬化患者. 这种非侵入性测试可以帮助避免肝病患者不必要的手术.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 肥胖和与代谢相关的脂肪性肝病/代谢相关的脂肪性肝炎 (MASLD/MASH) 可能会降低排除大食道静脉 (LEV) 的当前方法的准确性.
- 精确检测LEV和其他门高血压 (PH) 病变对于管理肝硬化患者至关重要.
研究的目的:
- 在美国多中心研究 (SHUNT-V) 中,评估疾病严重性指数 (DSI) 以检测内镜期间的LEV和其他PH病变.
- 评估DSI在识别患有Child-Pugh A肝硬化患者的实用性,这些患者可能会推迟对静脉的内镜查.
主要方法:
- 这项研究招募了患有补偿性肝硬化的成年人,他们接受内镜检查,以查水.
- 使用口服和静脉注射后的胆酸盐清除率来计算DSI.
- 评估了≤18.3的DSI截止值,以排除LEV,并预先定义了灵敏度和负概率的标准.
主要成果:
- 该研究包括306名受试者,其中275人具有DSI和内镜数据. 很大一部分患有MASLD/MASH,超重/肥胖或患有糖尿病.
- DSI在检测LEV (AUROC 0.81-0.82) 和所有显著PH病变 (AUROC 0.79-0.80) 中表现良好.
- DSI截止值≤18.3显示了对LEV和显著PH病变的高灵敏度 (96.3%-100%),可能使27% - 35%的内镜检查能够避免最小的错误诊断.
结论:
- 肝素DSI有效地预测了LEV和显著PH病变的可能性,在患者具有不同的特征和肝脏疾病病因.
- DSI是衡量肝功能和门体系统变流的指标,可以帮助临床决定延迟内镜检查儿童-皮格A肝硬化患者的静脉动脉.
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