Jedlicka J, Petrtýl J, Tesar V, Marecek Z, Cervinka J, Kordac V
Cas Lek Cesk. 1989 Aug 11;128(33):1035-9.
In 21 patients with bioptically confirmed cirrhosis of the liver catheterization of the lesser circulation and hepatic veins was performed. The portohepatic gradient was considered a measure of the portal pressure. The authors did not find a statistically significant relationship between the portohepatic gradient and the presence of oesophageal varices, haemorrhage into the gastrointestinal tract, biochemical parameters (albumin, gamma-globulin and bilirubin level) and the prothrombin time. The portohepatic gradient was not significantly related with the central venous pressure, the median pressure in the pulmonary artery and the pressure in the wedged pulmonary capillaries. It was, however, significantly higher in patients with ascites (p less than 0.05); patients in group B and C of Child-Turcott's classification had a portal gradient which was significantly higher than in patients of group A (p less than 0.01). The value of the cardiac index and the systemic vascular resistance was not related to values of the portohepatic gradient; a hyperkinetic circulation which a cardiac index above 4.5 l/min/m2 was recorded only in three patients. Based on the above results, the authors assume that a hyperkinetic circulation in patients of groups A and B according to Child-Turcott's classification is not a frequent finding and is not related to the value of the portal pressure. In the author's opinion the most suitable clinical indicator of the degree of portal hypertension is Child-Turcott's classification.
对21例经活检证实为肝硬化的患者进行了肝小循环和肝静脉的导管插入术。肝门梯度被视为门静脉压力的一种度量。作者未发现肝门梯度与食管静脉曲张的存在、胃肠道出血、生化参数（白蛋白、γ球蛋白和胆红素水平）及凝血酶原时间之间存在统计学上的显著关系。肝门梯度与中心静脉压、肺动脉平均压及楔压肺毛细血管压无显著相关性。然而，腹水患者的肝门梯度显著更高（p<0.05）；Child-Turcott分类中B组和C组患者的门静脉梯度显著高于A组患者（p<0.01）。心脏指数和全身血管阻力的值与肝门梯度值无关；仅在3例患者中记录到心脏指数高于4.5l/min/m2的高动力循环。基于上述结果，作者认为根据Child-Turcott分类，A组和B组患者的高动力循环并不常见，且与门静脉压力值无关。作者认为，门静脉高压程度最合适的临床指标是Child-Turcott分类。
