Методы прогнозирования риска и мониторинг эффективности терапии кровотечений из варикозно-расширенных вен пищевода у больных циррозом печени
Аннотация
Цель обзора. Описать методы прогнозирования риска кровотечений из варикозно-расширенных вен пищевода (ВРВП) у больных циррозом печени и показать роль некоторых из них в мониторинге эффективности терапии этого осложнения.
Основные положения. Фиброгастродуоденоскопия и измерение градиента печеночного венозного давления в настоящее время остаются общепринятыми методами скрининга больных циррозом печени для определения риска развития кровотечений из ВРВП. Присущие им недостатки способствовали изучению чувствительности и специфичности других предикторов этого осложнения, а также технологий, оценивающих тяжесть портальной гипертензии, таких как капсульная эндоскопия, допплеросонография, мультиспиральная компьютерная томография, неинвазивные способы диагностики фиброза печени и ряда других.
Заключение. Оптимизация известных методов оценки портальной гипертензии, а также разработка новых, основанных на патофизиологических механизмах ее развития, позволит повысить эффективность мероприятий, направленных на профилактику кровотечений из ВРВП у больных циррозом печени.
Список литературы
1. Гарбузенко Д.В. Патофизиологические механизмы и новые направления терапии портальной гипертензии при циррозе печени // Клин. перспективы гастроэнтерол. гепатол. – 2010. – № 6. – С. 11–20.
2. Турмаханов С.Т., Асадулаев Ш.М., Ахметкалиев М.Н. Морфоструктурные изменения непарной вены и вен гастроэзофагеальной зоны при портальной гипертензии // Анн. хирур. гепатол. – 2008. – Т. 13, № 2. – С. 58–65.
3. Abraldes J.G., Villanueva C., Bañares R. et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy // J. Hepatol. – 2008. – Vol. 48, N 2. – P. 229–236.
4. Adithan S., Venkatesan B., Sundarajan E. et al. Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed // Indian J. Radiol. Imaging. – 2010. – Vol. 20, N 4. – P. 289–293.
5. Baik S.K. Haemodynamic evaluation by Doppler ultrasonography in patients with portal hypertension: a review // Liver Int. – 2010. – Vol. 30, N 10. – P. 1403–1413.
6. Baik S.K., Kim J.W., Kim H.S. et al. Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response // Radiology. – 2006. – Vol. 240, N 2. – P. 574–580.
7. Berzigotti A., Gilabert R., Abraldes J.G. et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis // Am. J. Gastroenterol. – 2008. – Vol. 103, N 5. – P. 1159–1167.
8. Berzigotti A., Rossi V., Tiani C. et al. Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension // J. Gastroenterol. – 2011. – Vol. 46, N 5. – P. 687–695.
9. Bolognesi M., Merkel C., Sacerdoti et al. The role of spleen enlargement in cirrhosis with portal hypertension // Dig. Liver Dis. – 2002. – Vol. 34, N 2. – P. 144–150.
10. Bosch J., Bordas J.M., Rigau J. et al. Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: Comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy // Hepatology. – 1986. – Vol. 6, N 4. – P. 667–672.
11. Bosch J., Garcia-Pagan J.C., Berzigotti A., Abraldes J.G. Measurement of portal pressure and its role in the management of chronic liver disease // Semin. Liver Dis. – 2006. – Vol. 26, N 4. – P. 348–362.
12. Boyer T.D. Wedged hepatic vein pressure (WHVP): ready for prime time // Hepatology. – 2006. – Vol. 43, N 3. – P. 405–406.
13. Bureau C., Metivier S., Peron J.M. et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease // Aliment. Pharmacol. Ther. – 2008. – Vol. 27, N 12. – P. 1261–1268.
14. Burton J.R., Liangpunsakul S., Lapidus J. Validation of a multivariate model predicting presence and size of varices // J. Clin. Gastroenterol. – 2007. – Vol. 41, N 6. – P. 609–615.
15. Cherian J.V., Deepak N., Ponnusamy R.P. et al. Noninvasive predictors of esophageal varices // Saudi J. Gastroenterol. – 2011. – Vol. 17, N 1. – P. 64–68.
16. Chiang J.H., Lee R.C., Huang S.S. et al. Hepatofugal collaterals in advanced liver cirrhosis: Identification with CT portography // Chin. J. Radiol. – 2006. – Vol. 31. – P. 1–13.
17. Chitapanarux Т., Praisontarangkul О., Thongsawat S. et al. Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients // World J. Gastroenterol. – 2007. – Vol. 13, N 5. – P. 791–795.
18. D’Amico G., Garcia-Pagan C., Luca A., Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: A systematic review // Gastroenterology. – 2006. – Vol. 131, N 5. – P. 1611– 1624.
19. De Franchis R., Dell’Era A., Iannuzzi F. Diagnosis and treatment of portal hypertension // Dig. Liver Dis. – 2004. – Vol. 36, N 12. – P. 787–798.
20. De Mattos A.Z., De Mattos A.A., Vianna F.F. et al. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices // Arq. Gastroenterol. – 2010. – Vol. 47, N 3. – P. 275–278.
21. El-Zayadi A., Montasser M.F., Girgis F. et al. Histological changes of the esophageal mucosa in bleeding versus non-bleeding varices // Endoscopy. – 1989. – Vol. 21, N 5. – P. 205–207.
22. Erden A., Idilman R., Erden I. et al. MR angiography of esophageal mural veins in portal hypertension: a correlation with endoscopic grades of esophageal varices // Turk. J. Gastroenterol. – 2010. – Vol. 21, N 3. – P. 275–279.
23. Escorsell A., Bordas J.M., Castañeda B. et al. Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension // Hepatology. – 2000. – Vol. 31, N 5. – P. 1061–1067.
24. Fagundes E.D., Ferreira A.R., Roquete M.L. et al. Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome // J. Pediatr. Gastroenterol. Nutr. – 2008. – Vol. 46, N 2. – P. 178–183.
25. Feu F., Bordas J.M., Luca A. et al. Reduction of variceal pressure by propranolol: comparison of the effects on portal pressure and azygos blood flow in patient with cirrhosis // Hepatology. – 1993. – Vol. 18, N 5. – P. 1082–1089.
26. Gao L., Yang F., Ren C. et al. Diagnosis of cirrhotic portal hypertension and compensatory circulation using transsplenic portal scintigraphy with (99m)Tc-phytate // J. Nucl. Med. – 2010. – Vol. 51, N 1. – P. 52–56.
27. Garcia-Tsao G., Groszmann R.J., Fisher R.L. et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding // Hepatology. – 1985. – Vol. 5, N 3. – P. 419–424.
28. Giannini E.G., Zaman A., Kreil A. et al. Platelet count/ spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study // Am. J. Gastroenterol. – 2006. – Vol. 101, N 11. – P. 2511–2519.
29. Gupta D., Chawla Y.K., Dhiman R.K. et al. Clinical significance of patent paraumbilical vein in patients with liver cirrhosis // Dig. Dis. Sci. – 2000. – Vol. 45, N 9. – P. 1861–1864.
30. Hashizume M., Kitano S., Sugimaschi K., Sueishi K. Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension // Hepatology. – 1988. – Vol. 8, N 6. – P. 1482–1487.
31. Hosking S.W., Robinson P., Johnson A.G. Usefulness of manometric assessment of varices in maintenance sclerotherapy A controlled trial // Gastroenterology. – 1987. – Vol. 93, N 4. – P. 846–851.
32. Hussain Q., Badruddin A.H., Chaudhry M.A. et al. Effect of carvedilol on portal pressure estimated by hepatic vein Doppler ultrasound waveform and damping index in cirrhotic patients // J. Coll. Physicians Surg. Pak. – 2010. – Vol. 20, N 9. – P. 586–589.
33. Irisawa A., Obara K., Bhutani M.S. et al. Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis // J. Gastroenterol. Hepatol. – 2003. – Vol. 18, N 3. – P. 309–314.
34. Joseph T., Madhavan M., Devadas K., Ramakrishnannair V.K. Doppler assessment of hepatic venous waves for predicting large varices in cirrhotic patients // Saudi J. Gastroenterol. – 2011. – Vol. 17, N 1. – P. 36–39.
35. Kim B.K., Han K.H., Park J.Y. et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis // Am. J. Gastroenterol. – 2010. – Vol. 105, N 6. – P. 1382–1390.
36. Kim B.K., Han K.H., Park J.Y. et al. Prospective validation of P2/MS noninvasive index using complete blood counts for detecting esophageal varices in B-viral cirrhosis // Liver Int. – 2010 . – Vol. 30, N 6. – P. 860–866.
37. Kim S.H., Kim Y.J., Lee J.M. et al. Esophageal varices in patients with cirrhosis: Multidetector CT esophagography – comparison with endoscopy // Radiology. – 2007. – Vol. 242, N 3. – P.758–768.
38. Kim Y.J., Raman S.S., Yu N.C. et al. Esophageal varices in cirrhotic patients: Evaluation with liver CT
39. // Am. J. Radiol. – 2007. – Vol. 188, N 1. – P. 139–144.
40. Kimura T., Moriyasu F., Kawasaki T. et al. Relationship between esophageal varices and azygos vein evaluated by cineportography // Hepatology. – 1991. – Vol. 13, N 5. – P. 858–864.
41. Kodama H., Aikata H., Takaki S. et al. Evaluation of patients with esophageal varices after endoscopic injection sclerotherapy using multiplanar reconstruction MDCT images // Am. J. Roentgenol. – 2009. – Vol. 192, N 1. – P. 122–130.
42. Krige J.E., Kotze U.K., Distiller G. Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding: a multivariate analysis // World J. Surg. – 2009. – Vol. 33, N 10. – P. 2127–2135.
43. Krogsgaard K., Gluud C., Henriksen J.H. et al. Correlation between liver morphology and portal pressure in alcoholic liver disease // Hepatology. – 1984. – Vol. 4, N 3. – P. 699–703.
44. Kropf J., Gressner A.M., Tittor W. Logistic-regression model for assessing portal hypertension by measuring hyaluronic acid (hyaluronan) and laminin in serum // Clin. Chem. – 1991. – Vol. 37, N 1. – P. 30–35.
45. La Mura V., Abraldes J.G., Raffa S. et al. Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension // J. Hepatol. – 2009. – Vol. 51, N 2. – P. 279–287.
46. Lee N.M., Eisen G.M. 10 years of capsule endoscopy: an update // Expert. Rev. Gastroenterol. Hepatol. – 2010. – Vol. 4, N 4. – P.503–512.
47. Lee Y.T., Sung J., Yung M.Y. et al. Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension // Gastrointest. Endosc. – 1999. – Vol. 50, N 1. – P. 47–52.
48. Lemoine M., Katsahian S., Ziol M. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis // Aliment. Pharmacol. Ther. – 2008. – Vol. 28, N 9. – P. 1102–1110.
49. Liu C.H., Hsu S.J., Liang C.C. et al. Esophageal varices: noninvasive diagnosis with duplex Doppler US in patients with compensated cirrhosis // Radiology. – 2008. – Vol. 248, N 1. – P. 132–139.
50. Merkel C., Bolognesi M., Sacerdoti D. et al. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxys of variceal bleeding in cirrhosis // Hepatology. – 2000. – Vol. 32, N 5. – P. 930–934.
51. Noda T. Angioarchitectural study of esophageal varices with special reference to variceal rupture // Virchows Arch. – 1984. – Vol. 404, N 4. – P. 381–392.
52. Perri R.E., Chiorean M.V., Fidler J. et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices // Hepatology. – 2008. – Vol. 47, N 5. – P. 1587– 1594.
53. Qamar A.A., Grace N.D., Groszmann R.J. et al. Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis // Hepatology. – 2008. – Vol. 47, N 1. – P. 153–159.
54. Ruiz del Arbol L., Martin de Argila C., Vazquez M. et al. Endoscopic measurement of variceal pressure during hemorrhage from esophageal varices // Hepatology. – 1992. – Vol. 16 (suppl. 1). – 147A.
55. Sato T., Yamazaki K., Toyota J. et al. Endoscopic ultrasonographic evaluation of hemodynamics related to variceal relapse in esophageal variceal patients // Hepatol. Res. – 2009. – Vol. 39, N 2. – P. 126–133.
56. Schreibman I., Meitz K., Kunselman A.R. et al. Defining the threshold: new data on the ability of capsule endoscopy to discriminate the size of esophageal varices // Dig. Dis. Sci. – 2011. – Vol. 56, N 1. – P. 220–226.
57. Silkauskaite V., Pranculis A., Mitraite D. et al. Hepatic venous pressure gradient measurement in patients with liver cirrhosis: a correlation with disease severity and variceal bleeding // Medicina (Kaunas). – 2009. – Vol. 45, N 1. – P. 8–13.
58. Stefanescu H., Grigorescu M., Lupsor M. et al. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients // J. Gastroenterol. Hepatol. – 2011. – Vol. 26, N 1. – P. 164–170.
59. Sukigara M., Shimoji K., Ohata M. et al. Effects of propranolol and nitroglycerin on cephalad collateral venous flow in patients with cirrhosis: evaluation using transesophageal real-time two-dimensional Doppler echography // Am. J. Gastroenterol. – 1988. – Vol. 83, N 11. – P. 1248–1254.
60. Tacke F., Fiedler K., Trautwein C. A simple clinical score predicts high risk for upper gastrointestinal hemorrhages from varices in patients with chronic liver disease // Scand. J. Gastroenterol. – 2007. – Vol. 42, N 3. – P. 374–382.
61. Tarzamni M.K., Somi M.H., Farhang M., Jalilvand M. Portal hemodynamics as predictors of risk esophageal varices in cirrhotic patients // World J. Gastroenterol. – 2008. – Vol. 14, N 12. – P. 1898–1902.
62. Thabut D., Imbert-Bismut F., Cazals-Hatem D. et al. Relationship between the Fibrotest and portal hypertension in patients with liver disease // Aliment. Pharmacol. Ther. – 2007. – Vol. 26, N 3. – P. 359–368.
63. Vianna A., Hayes P.C., Moscoso G. et al. Normal venous circulation of the gastroesophageal junction // Gastroenterology – 1987. – Vol. 93, N 4. – P. 876–889.
64. Vizzutti F., Arena U., Romanelli R.G. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis // Hepatology. – 2007. – Vol. 45, N 5. – P. 1290–1297.
65. Vorobioff J., Bredfeldt J.E., Groszmann J. Hyperdynamic circulation in portal hypertensive rat model: a primary factor for maintenence of chronic portal hypertension // Am. J. Physiol. – 1983. – Vol. 244, N 1. – P. 52–57.
66. Zhang C.X., Hu J., Hu K.W. et al. Noninvasive analysis of portal pressure by contrast-enhanced sonography in patients with cirrhosis // J. Ultrasound Med. – 2011. – Vol. 30, N 2. – P. 205–211.
67. Zhang L., Duan Y.Y., Li J.M, Yin J.K. Hemodynamic features of doppler ultrasonography in patients with portal hypertension: Intraoperative direct measurement of portal pressure in the portal venous system // J. Ultrasound Med. – 2007. – Vol. 26, N 12. – P. 1689–1696.
Рецензия
Для цитирования:
Гарбузенко Д.В. Методы прогнозирования риска и мониторинг эффективности терапии кровотечений из варикозно-расширенных вен пищевода у больных циррозом печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2012;22(2):36-44.
For citation:
Garbuzenko D.V. Methods of risk prediction and monitoring of treatment response rate of bleedings from esophageal varices in patients with liver cirrhosis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(2):36-44. (In Russ.)
Просмотров:
74
Контент доступен под лицензией Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Послать статью по эл. почте 
