肝硬化是各种慢性肝病进展至以肝脏弥漫性纤维化、假小叶形成、肝内外血管增殖为特征的病理阶段，失代偿期患者常因并发症导致多脏器功能衰竭而死亡。肝组织活检、肝静脉压力梯（HVPG）等传统检测为有创操作，临床应用受限，不利于疾病监测和患者及时救治。
第57届欧洲肝病研究学会年会（EASL2022）暨2022年国际肝脏大会TM（ILC 2022）上，聚焦晚期肝病诊治创新技术的“临床肝病学的未来：放射学、内镜检查和机器人手术创新”专题备受关注。西班牙巴塞罗那临床医院消化疾病研究所教员和顾问、巴塞罗那大学医学副教授Andres Cardenas博士主持并参与专题病例展示和讨论。《国际肝病》记者有幸在现场采访到Cardenas教授，请他介绍门静脉高压无创诊断、超声内镜的应用，以及晚期肝病其他新兴技术。
《国际肝病》：肝静脉压力梯（HVPG）在肝硬化分期、并发症发生和治疗目标评估中均具有较重要的价值。但有创检测限制了其临床应用。适用于肝硬化患者的无创动态检测新技术有哪些？
Andres Cardenas教授：HVPG一直是测量门静脉压力和评估肝静脉压的“金标准”。这是一种需要放射学辅助的侵入性技术，旨在让我们了解门静脉高压症的肝阻力程度。但由于侵入性缺点，患者必须入院接受检测。CT扫描、MRCP和特殊超声成像等无创检测技术可能可以告诉我们关于肝脏的信息。例如，CT扫描和超声成像领域已开发出新的软件，可以帮助我们尝试评估门静脉高压的程度。但这些方法尚在研究中，需要验证以确定门脉压力值是否存在动态变化。总体而言，未来前沿技术聚焦在门静脉高压的无创检测，HVPG和门脉压力的无创评估。
英文原文：
：Hepatic venous pressure gradient (HVPG) has important value in liver cirrhosis staging, complication occurrence and evaluation of treatment goals. However, invasive detection limits its clinical application. Could you please introduce a new technology for non-invasive dynamic detection of HVPG in patients with liver cirrhosis?
Prof. Andres Cardenas：HVPG has been the gold standard for measuring portal pressure and estimated hepatic venous pressure. The goal of this technique is to inform us of the degree of liver resistance in portal hypertension. It is an invasive technique that requires radiology, and also has the disadvantage of being invasive, and the patient has to come in to the hospital for that. Although it is the gold standard for measuring estimated portal pressure, it is invasive, and there are other techniques, such as CT scan, MRCP and special ultrasound imaging, that can probably tell us about the liver. There is new software in the CT scan area and ultrasound area that can help us try to estimate the degree of portal hypertension. That being said, these methods are still all being studied and need to be validated in order to tell us if there is a dynamic change in the value of portal pressure. So the future that lies ahead is non-invasive measurement of portal hypertension, and non-invasive estimation of HVPG and portal pressure.
《国际肝病》：内镜是肝硬化及其并发症诊断和治疗的重要工具。近来热议的新技术——超声内镜，其在肝病中的应用如何？
Andres Cardenas教授：内镜检查是肝硬化患者的常用诊疗工具。肝硬化患者内镜检查的主要适应证是观察患者是否有静脉曲张。然而，也有一些非侵入性方法可用来判断静脉曲张是否存在，例如肝脏瞬时弹性成像检查（FibroScan?）和血小板计数。如果患者的FibroScan?检测值较低而血小板计数较高，则说明这些患者可能不需要内镜检查。而其他所有患有肝硬化或FibroScan?检测值高的患者，则需要进行内镜检查以评估胃静脉曲张和食管静脉曲张是否存在，以及曲张大小和特征。
超声内镜在肝硬化诊疗中发挥重要作用。它不仅可以协助评估肝脏表面情况，还可以协助判断是否有肝脏结节。此外，也有使用超声内镜测量门静脉压力的方法，虽然这仍处于起步阶段，但它也是测量门静脉压力的一种方法。然而在我们将其视为评估门脉压力的工具之前，我们还需要开展更多的验证和获得更全面的信息。未来我们会知道这项技术是否可以安全地用于我们的肝硬化患者。
英文原文：
：Endoscopy is an important tool for the diagnosis and treatment of liver cirrhosis and its complications. The recently discussed new technology - endoscopic ultrasonography, how is its application in hepatology?
Prof. Andres Cardenas：Endoscopy is a tool that we use for our patients with cirrhosis. The main indication for endoscopy in patients with cirrhosis is to see if the patient has varices or not. However, there are non-invasive ways of estimating the presence of varices with what we call FibroScan and platelet counts. So if you have a low FibroScan count and a high platelet count, these patients probably don’t need an endoscopy. For all the other patients who have cirrhosis or high FibroScan, we need to do an endoscopy to evaluate the presence, size and characteristics of gastric varices and esophageal varices if present.
The role of endoscopic ultrasound in cirrhosis is important. It can help you evaluate the liver surface, and it can also help you evaluate if there are liver nodules or not. There are also ways of measuring portal pressure with endoscopic ultrasound. This is still in its infancy, but is another way of measuring portal pressure. However, we need more validation and more information before we consider this a tool for estimating portal pressure. The future will tell us if this technique is something that can be implemented safely in our patients with cirrhosis.
《国际肝病》：对于晚期肝病的诊治，您认为还有哪些较具前景的新技术有望在临床应用？
Andres Cardenas教授：可用于临床的新技术基本有两种。一种是血液标志物的测量，它可以帮助我们评估疾病进展的风险，也可以帮助我们评估是否存在慢性肝病。除此之外，新技术还包括使用成像技术，如MRI、MRE、CT扫描和CT扫描动态成像。这些技术将帮助我们通过无创的方式确定患者是否患有肝硬化；如果他们有肝硬化，这些技术可以帮助我们评估患者可能患有的肝病严重程度，以及门静脉高压的程度。这些技术能帮助我们更好地诊断疾病并治疗患者，延缓疾病的进展。在某些情况下，肝硬化患者可能会明显受益于β受体阻滞剂、利福昔明等抗生素；此外，在某些情况下，他汀类药物也有助于降低门静脉压力。
英文原文：
：For the diagnosis and treatment of advanced liver disease, what other promising new technologies do you think are expected to be used in clinical practice?
Prof. Andres Cardenas：The new technologies that can be used in clinical practice are basically two. One is measurement of blood markers that can help us estimate risk of disease progression, and also help us estimate the presence or not of chronic liver disease. In addition to that, new technologies include the use of imaging techniques such as MRI, MR elastography, CT scan and CT scan dynamic imaging. These techniques will non-invasively help us to decide if a patient has cirrhosis or not; and if they have cirrhosis, to help us estimate the degree of liver disease that patient may have, and the degree of portal hypertension. These techniques will allow us to diagnose our patients better, and therapies will help us slow progression of disease. In some cases, patients with cirrhosis may benefit obviously from beta-blockers, antibiotics such as rifaximin, and in some cases, with statins, that can help lower portal pressure.
《国际肝病》：Portal Hypertension & Cirrhosis是门脉高压症研究领域出版的第一种同行评议期刊。作为编委，能否请您谈谈对该期刊的期待？
Andres Cardenas教授：这是一本专注于门静脉高压症和肝硬化的新期刊。它是独一无二的，很高兴看到有一本专注于肝病这一领域的期刊。显然，最重要的是尽量吸引原创稿件，并审查可以发表和引用的稿件，以使期刊在肝病学领域获得一些影响力。我们需要观察一段时间，看情况的发展。然后希望我们有足够的投稿来推动引用、推动影响因子，希望其成为肝病学领域的重要期刊之一。
英文原文：
：Portal Hypertension & Cirrhosis is the first peer-reviewed journal published in the field of portal hypertension research. As an editorial board member, could you please talk about your expectations for the journal?
Prof. Andres Cardenas：This is a new journal that focuses on portal hypertension and cirrhosis. It is one-of-a-kind, and it is exciting to see that there is a journal that is going to be focusing on this area of liver disease. Obviously, the most important thing is to try to attract manuscripts that are original, and to review manuscripts that can be published and cited so the journal can gain some impact in the world of hepatology. With time, we will see if this is the case, and then hopefully we will have enough submissions to drive citations, drive the impact factor, and hopefully make it one of the important journals in hepatology.
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