肝硬化门静脉高压无创评估进展

Progress in Non-Invasive Assessment of Portal Hypertension in Cirrhosis

摘要: 门静脉高压(Portal hypertension, PH)作为肝硬化失代偿的核心病理生理特征，其特征性临床表现包括侧枝循环形成、脾功能亢进、腹水形成。尤其是临床显著性门静脉高压(clinically significant portal hypertension, CSPH)，标志着肝硬化病程进入失代偿拐点，预后显著恶化。当前肝静脉压力梯度检测(Hepatic Venous Pressure Gradient, HVPG)是评估门脉压力的金标准，虽能精准量化门脉压力，但受限于侵入性操作风险、穿刺并发症及单次检测费用高等现实因素，在临床诊疗工作中受到限制。随着无创评估技术的发展，血清学生物标志物分析、超声肝脾硬度测定和CT影像组学等无创模型取得突破。有效的无创评估门静脉压力的方法，能使医生更好地评估肝硬化患者病情及其并发症管理，改善患者的预后。

Abstract: Portal hypertension (PH), as the core pathophysiological feature of decompensated cirrhosis, is characterized by clinical manifestations such as collateral circulation formation, hypersplenism, and ascites. Clinically significant portal hypertension (CSPH), in particular, marks a critical turning point in the progression of cirrhosis toward decompensation and is associated with significantly worsened prognosis. Currently, hepatic venous pressure gradient (HVPG) measurement remains the gold standard for assessing portal pressure. While it provides precise quantification of portal pressure, its clinical application is limited by practical challenges including invasive procedural risks, puncture-related complications, and high costs of single measurements. With advancements in non-invasive evaluation techniques, breakthroughs have been achieved in non-invasive models such as serum biomarker analysis, ultrasound-based liver and spleen stiffness measurements, and CT radiomics. Effective non-invasive methods for assessing portal pressure enable clinicians to better evaluate disease progression and complication management in cirrhosis patients, ultimately improving clinical outcomes.