乙型肝炎肝硬化不同肝静脉解剖结构下肝静脉压力梯度与门静脉压力梯度的相关性。
Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy.
机构信息
Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Department of Statistics, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China.
出版信息
Eur J Radiol. 2022 Oct;155:110463. doi: 10.1016/j.ejrad.2022.110463. Epub 2022 Aug 6.
PURPOSE
The hepatic venous pressure gradient (HVPG) has been employed as the gold standard for indicating the portal venous pressure gradient (PPG) in the diagnosis of portal hypertension (PHT). However, little has been reported on whether the HVPG can accurately estimate the PPG in patients with hepatic vein collateral shunts. We aimed to explore the correlation between the HVPG and the PPG in hepatitis B cirrhosis patients with different hepatic vein anatomies.
METHODS
A total of 461 hepatitis B cirrhosis patients with portal hypertension (PHT) who were treated with a transjugular intrahepatic portosystemic shunt (TIPS) between January 2016 and June 2020 were included. All patients underwent various venous pressure measurements and balloon-occluded compression hepatic venography during the TIPS operation. Agreements were evaluated by Pearson's correlation and the Bland-Altman method. Disagreements were assessed by paired t tests.
RESULTS
The correlation coefficient (r) values (P < 0.001) between the HVPG and the PPG of the early (151 patients, 32.8 %), middle (73 patients, 15.8 %), late (46 patients, 10.0 %), portal vein (151 patients, 32.8 %), and no lateral branch development groups (40 patients, 8.7 %) were 0.373, 0.487, 0.569, 0.690, and 0.575, respectively; the determination coefficient (R) values were 0.139, 0.238, 0.323, 0.475, and 0.330, respectively. According to the Bland-Altman method, agreement was the greatest in the portal vein development group, with the 95 % limits of agreement (95 % LoA, mean differences ± 1.96 SD) being the smallest. The differences were statistically significant (P < 0.05).
CONCLUSION
The correlation between the HVPG and the PPG is the worst in early lateral branch development, followed by middle development, and the influence of lateral branches becomes significantly reduced in late development. Hepatic venous collateral formation is a vital factor for underestimation of the HVPG, which is the most accurate predictor of PPG in patients with portal vein development. Patients with no collateral channel development in the hepatic vein have a higher HVPG than PPG, which is an important reason for overestimation of the HVPG.
目的
肝静脉压力梯度（HVPG）已被用作诊断门静脉高压症（PHT）时门静脉压力梯度（PPG）的金标准。然而，关于 HVPG 是否能准确估计有肝静脉侧支分流的患者的 PPG，报道甚少。本研究旨在探讨不同肝静脉解剖结构的乙型肝炎肝硬化患者中 HVPG 与 PPG 之间的相关性。
方法
共纳入 2016 年 1 月至 2020 年 6 月期间因 PHT 接受经颈静脉肝内门体分流术（TIPS）治疗的 461 例乙型肝炎肝硬化患者。所有患者在 TIPS 手术期间均进行了各种静脉压测量和球囊阻塞性肝静脉造影。通过 Pearson 相关和 Bland-Altman 法评估一致性。通过配对 t 检验评估差异。
结果
HVPG 与早期（151 例，32.8%）、中期（73 例，15.8%）、晚期（46 例，10.0%）、门静脉（151 例，32.8%）和无侧支发育组（40 例，8.7%）的 PPG 的相关系数（r 值）分别为 0.373、0.487、0.569、0.690 和 0.575，决定系数（R 值）分别为 0.139、0.238、0.323、0.475 和 0.330。根据 Bland-Altman 法，门静脉发育组的一致性最大，95%一致性界限（95% LoA，平均差值±1.96 SD）最小。差异具有统计学意义（P<0.05）。
结论
HVPG 与 PPG 的相关性在早期侧支发育时最差，其次是中期发育，侧支发育后期影响显著降低。肝静脉侧支形成是 HVPG 低估的重要因素，在有门静脉发育的患者中，HVPG 是 PPG 最准确的预测指标。无肝静脉侧支通道发育的患者 HVPG 高于 PPG，这是 HVPG 高估的重要原因。
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