肝硬化和非肝硬化门静脉纤维化患者肝楔压、肝内压、脾内压和曲张静脉内压的测量及相关性研究
Measurement and correlation of wedged hepatic, intrahepatic, intrasplenic and intravariceal pressures in patients with cirrhosis of liver and non-cirrhotic portal fibrosis.
作者信息
Sarin S K, Sethi K K, Nanda R
出版信息
Gut. 1987 Mar;28(3):260-6. doi: 10.1136/gut.28.3.260.
In order to examine the relationship of various haemodynamic parameters in two different liver diseases, 10 patients with cirrhosis of liver and 14 patients with non-cirrhotic portal fibrosis were studied. In cirrhotics, mean (+/- SD) wedged hepatic (25.8 +/- 6.4 mmHg), intrahepatic (24.5 +/- 6.2 mmHg) and intrasplenic (25.0 +/- 5.6 mmHg) pressures correlated significantly (p less than 0.001) with intravariceal (25.2 +/- 6.7) pressure measurements. In patients with NCPF, mean (+/- SD) wedged hepatic (9.1 +/- 3.7 mmHg) and intraphepatic (15.4 +/- 5.8 mmHg) pressures were significantly (p less than 0.01) lower than the intrasplenic (24.5 +/- 4.2 mmHg) and intravariceal (23.96 +/- 5.6 mmHg) pressures. Two independent pressure gradients, one between intrasplenic and intrahepatic pressure (8.9 +/- 6.5 mmHg) and another between intrahepatic and wedged hepatic venous pressure (6.2 +/- 5.6 mmHg) were seen in non-cirrhotic portal fibrosis patients, indicating the likelihood of both pre- and perisinusoidal resistance to flow of portal venous blood in these patients. A highly significant (p less than 0.001) correlation between intravariceal and intrasplenic pressures was found in patients with cirrhosis of liver (r = 0.93), as well as in patients with non-cirrhotic portal fibrosis (r = 0.85). No correlation was found between the size of oesophageal varices and wedged hepatic and intrahepatic pressures. Patients with grade 4 varices had significantly higher intravariceal (p less than 0.01) and intrasplenic (p less than 0.05) pressure than patients with grade 2 varices. It can be concluded that intravariceal pressure is representative of portal pressure in patients with cirrhosis of liver as well as in non-cirrhotic portal fibrosis patients and it can be recommended as the single haemodynamic investigation in patients with portal hypertension and oesophageal varices.
为了研究两种不同肝脏疾病中各种血流动力学参数之间的关系，我们对10例肝硬化患者和14例非肝硬化性门静脉纤维化患者进行了研究。在肝硬化患者中，平均（±标准差）肝静脉楔压（25.8±6.4 mmHg）、肝内压（24.5±6.2 mmHg）和脾内压（25.0±5.6 mmHg）与曲张静脉内压（25.2±6.7）测量值显著相关（p<0.001）。在非肝硬化性门静脉纤维化患者中，平均（±标准差）肝静脉楔压（9.1±3.7 mmHg）和肝内压（15.4±5.8 mmHg）显著低于脾内压（24.5±4.2 mmHg）和曲张静脉内压（23.96±5.6 mmHg）（p<0.01）。在非肝硬化性门静脉纤维化患者中发现了两个独立的压力梯度，一个是脾内压与肝内压之间的压力梯度（8.9±6.5 mmHg），另一个是肝内压与肝静脉楔压之间的压力梯度（6.2±5.6 mmHg），这表明这些患者门静脉血流在窦前和窦周均存在阻力。在肝硬化患者（r=0.93）以及非肝硬化性门静脉纤维化患者（r=0.85）中，曲张静脉内压与脾内压之间存在高度显著的相关性（p<0.001）。未发现食管静脉曲张大小与肝静脉楔压和肝内压之间存在相关性。4级静脉曲张患者的曲张静脉内压（p<0.01）和脾内压（p<0.05）显著高于2级静脉曲张患者。可以得出结论，曲张静脉内压代表肝硬化患者以及非肝硬化性门静脉纤维化患者的门静脉压力，对于门静脉高压和食管静脉曲张患者，可推荐将其作为单一的血流动力学检查方法。
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