Mohran Zakaria, Sakr Mohamed, Barakat Eman, Elbaz Ahmed, Al-Hamid Mohamed Abd, Abou-Elmaaty Mohamed
J Egypt Soc Parasitol. 2015 Dec;45(3):545-54. doi: 10.12816/0017914.
The reference standard for portal venous pressure measurement which is clinically important for estimating the. feasibility of resection of hepatocellular carcinoma is the hepatic venous pressure gradient, which is, invasive and expqnsive. The present study evaluated the noninvasive parameters for assessment of portal hypertension in Child A patients with hepatocellular carcinoma on top of hepatitis C virus. A total of 112 patients were subjected to clinical assessment, biochemical assay, ultrasonographic Doppler study, triphasic spiral abdominal computed tomography, upper gastrointestinal endoscopy and hepatic venous pressure gradient measurement. According to hepatic venous pressure gradient measurement, they were classified into groups: GI: 58 patients with hepatic venous pressure gradient <10 mmHg and GII: 54 patients with hepatic venous pressure gradient > or = 10 mmHg. Significant variables in univariate analysis were included in a multivariate analysis to establish a model for prediction of clinically significant portal hypertension. Results showed that portal vein diameter > or = 1.3 cm, mono or biphasic pattern of flow in hepatic veins and Giannini index < or = 909 were independent risk factors for the clinically significant portal hypertension as indicated by HVPG > or = 10 mmHg. A model with highest likelihood ratio and good fitness was created. This prediction model was displayed by the receiver operating characteristic curve and under the curve area was 0.969 (0.938-1).
门静脉压力测量的参考标准对评估肝细胞癌切除的可行性具有临床重要性，即肝静脉压力梯度，但该方法具有侵入性且费用高昂。本研究评估了丙型肝炎病毒感染的Child A级肝细胞癌患者门静脉高压的非侵入性参数。共112例患者接受了临床评估、生化检测、超声多普勒检查、三相螺旋腹部计算机断层扫描、上消化道内镜检查和肝静脉压力梯度测量。根据肝静脉压力梯度测量结果，将他们分为两组：GI组：58例肝静脉压力梯度<10 mmHg的患者；GII组：54例肝静脉压力梯度≥10 mmHg的患者。单因素分析中的显著变量纳入多因素分析，以建立预测临床显著门静脉高压的模型。结果显示，门静脉直径≥1.3 cm、肝静脉血流呈单相或双相模式以及詹尼尼指数≤909是肝静脉压力梯度≥10 mmHg所提示的临床显著门静脉高压的独立危险因素。创建了一个似然比最高且拟合良好的模型。该预测模型通过受试者工作特征曲线展示，曲线下面积为0.969（0.938 - 1）。
