Spahr Laurent, Giostra Emile, Morard Isabelle, Mentha Gilles, Hadengue Antoine
Gastroenterogy and Hepatology, Hôpitaux Universitaire de Genève, 24 Rue Micheli-du-Crest, 1211 Geneva 4, Switzerland.
Gastroenterol Clin Biol. 2006 Aug-Sep;30(8-9):1012-8. doi: 10.1016/s0399-8320(06)73376-0.
In patients with cirrhosis, the hepatic venous pressure gradient (HVPG) is the reference method for the assessment of portal hypertension (PHT). Variceal pressure (VP) may be measured at endoscopy, but its relationship to the HVPG remains controversial. The aim of the study was to retrospectively compare HVPG and VP values obtained in a cohort of patients with cirrhosis and PHT.
Within 8 days (range: 6-10 days), 64 patients in a stable condition with biopsy-proven cirrhosis [alcoholic: 47; other 17; mean age: 56.5 yrs (35-70); mean Child-Pugh's score: 9.4 +/- 1.9; ascites: 37/64; previous variceal bleeding (="bleeders"): 24/64) and oesophageal varices (grade 2: 49; grade 3: 15)] underwent both measurement of the HVPG during transjugular liver biopsy and VP at endoscopy using a "home made" pressure sensitive gauge in the absence of needle puncture of the varix. Alcoholic hepatitis was present in 28 patients with alcoholic cirrhosis.
The pressure sensitive gauge was well tolerated. The mean HVPG and VP values were 18.5 +/- 3.4 mmHg and 19 +/- 3.7 mmHg, respectively. A significant difference was observed between "bleeders" (n=24) and non "bleeders" (n=40) in terms of VP values (21.4 +/- 3.3 vs 17.2 +/- 3.2 mmHg, P<0.001), but not for HVPG values (19.4 +/- 4.1 vs 17.9 +/- 2.8 mmHg, P=0.075). A positive correlation was observed between VP and HVPG values (r=0.62, P<0.0001).
In this group of patients with cirrhosis and oesophageal varices, a "home-made" pressure sensitive gauge allowed a non invasive perendoscopic measurement of VP. The positive correlation between VP and HVPG values suggests that measurement of VP may be a reliable estimate of portal pressure in these patients.
在肝硬化患者中，肝静脉压力梯度（HVPG）是评估门静脉高压（PHT）的参考方法。可在内镜检查时测量曲张静脉压力（VP），但其与HVPG的关系仍存在争议。本研究的目的是回顾性比较一组肝硬化和PHT患者的HVPG和VP值。
在8天内（范围：6 - 10天），64例病情稳定、经活检证实为肝硬化的患者[酒精性肝硬化：47例；其他原因肝硬化：17例；平均年龄：56.5岁（35 - 70岁）；平均Child-Pugh评分：9.4±1.9；腹水：37/64；既往有曲张静脉出血（即“出血者”）：24/64]，且患有食管静脉曲张（2级：49例；3级：15例），在经颈静脉肝活检期间测量HVPG，并在内镜检查时使用“自制”压力敏感计在不穿刺曲张静脉的情况下测量VP。28例酒精性肝硬化患者存在酒精性肝炎。
压力敏感计耐受性良好。HVPG和VP的平均值分别为18.5±3.4 mmHg和19±3.7 mmHg。在“出血者”（n = 24）和非“出血者”（n = 40）之间，VP值存在显著差异（21.4±3.3 vs 17.2±3.2 mmHg，P < 0.001），但HVPG值无显著差异（19.4±4.1 vs 17.9±2.8 mmHg，P = 0.075）。VP和HVPG值之间存在正相关（r = 0.62，P < 0.0001）。
在这组肝硬化和食管静脉曲张患者中，“自制”压力敏感计允许在内镜检查时进行无创性VP测量。VP和HVPG值之间的正相关表明，VP测量可能是这些患者门静脉压力的可靠估计值。
