严重的门脉高压会引起并发症，甚至死亡。虽然测量肝静脉压力梯度是评价有无门静脉高压及其严重程度最准确的方法，但是这种技术是有创的，因此所有临床中心均未将之作为常规方法。最新一期的《肝脏病学》对肝硬化患者门脉高压的无创性评估进行了综述。
目前，有人提出了数种无创性技术检测门静脉高压。例如，有的方法是通过检测有无多动症评价与门静脉高压发病机制有关的元素，或通过测量肝内血管阻力有无增加研究肝纤维化的进展。其他方法评价的是门静脉高压的临床结局，例如有无食管静脉曲张或门体分流。评价肝血管阻力的方法是很准确的，主要是通过血清标志物和瞬态弹性成像检测有无肝纤维化。通过影像学评估多动症可能有用，但目前仍处于研究阶段。应用生物学测定、计算机断层扫描和食管胶囊等简单的方法检测有无静脉曲张，进而评估严重门静脉高压。更复杂的方法有应用前景，但目前仍处于研发阶段。在大型人群中进行筛查的方法必须简单，而较为复杂的方法有助于确诊患者的随访。虽然上述无创性方法大多可有效地鉴定严重门静脉高压，但仍需研发诊断中度门静脉高压的方法；这表明该领域仍需进行更多研究。
医脉通推荐英文摘要：
Hepatology. 2011 Feb;53(2):683-94. |doi: 10.1002/hep.24129.
Noninvasive assessment of portal hypertension in patients with cirrhosis.
Thabut D, Moreau R, Lebrec D.
Severe portal hypertension is responsible for complications and death. Although measurement of the hepatic venous pressure gradient is the most accurate method for evaluating the presence and severity of portal hypertension, this technique is considered invasive and is not routinely performed in all centers. Several noninvasive techniques have been proposed to measure portal hypertension. Certain methods evaluate elements related to the pathogenesis of portal hypertension through the measurement of hyperkinetic syndrome, for example, or they investigate the development of hepatic fibrosis through the measurement of increased intrahepatic vascular resistance. Other methods evaluate the clinical consequences of portal hypertension, such as the presence of esophageal varices or the development of portosystemic shunts. Methods evaluating increased hepatic vascular resistance are fairly accurate and mainly involve the detection of hepatic fibrosis by serum markers and transient elastography. The radiological assessment of hyperkinetic syndrome probably has value but is still under investigation. The assessment of severe portal hypertension by the presence of varices may be performed with simple tools such as biological assays, computed tomography, and esophageal capsules. More sophisticated procedures seem promising but are still under development. Screening tools for large populations must be simple, whereas more complicated procedures could help in the follow-up of already diagnosed patients. Although most of these noninvasive methods effectively identify severe portal hypertension, methods for diagnosing moderate portal hypertension need to be developed; this shows that further investigation is needed in this field.
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