Wang L, Song Q K, Yue Z D, Zhao H W, Fan Z H, Wu Y F, Liu F Q, Meng K, Zhang L, Jiang H G, Ding Y N, Zhang Yuening
Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Science and Technology Division Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Jul 20;30(7):722-727. doi: 10.3760/cma.j.cn501113-20200603-00291.
To explore the correlation between portal vein pressure gradient (PPG) and hepatic vein pressure gradient (HVPG) in patients with portal hypertension (PHT). 752 cases with portal hypertension (PHT) who underwent transjugular intrahepatic portosystemic shunt (TIPS) and met the enrollment criteria between January 2016 to December 2019 were analyzed for hepatic vein, inferior vena cava and portal vein pressure. Paired t-test was used for analysis. Pearson correlation test was used to estimate correlation coefficient and coefficient of determination. <0.05 were considered statistically significant. Wedged hepatic vein pressure (WHVP), portal vein pressure (PVP), correlation coefficient, and coefficient of determination were 27.98±8.95 mmHg, 33.85±7.33 mmHg, 0.329 (<0.001), and 0.108, respectively. HVPG, PPG,correlation coefficient, and coefficient of determination were 16.84±7.97 mmHg, 25.11±6.95 mmHg (<0.001), 0.145, and 0.021 (<0.001), respectively. The difference between HVPG and PPG was greater than 5 mmHg in 524 cases, accounting for 69.7%. The difference between HVPG and PPG was within 5 mmHg or basically equal in 228 cases, accounting for 30.3%. The correlation coefficient between free hepatic venous pressure (FHVP) and inferior vena cava pressure (IVCP) was 0.568 (<0.001), and the coefficient of determination was 0.323. According to the presence or absence of hepatic venous collaterals after balloon occluded hepatic angiography, they were divided into two groups: 157 (20.9%) cases in the group with hepatic venous collaterals, and 595 (79.1%) cases in the group without hepatic venous collaterals. The parameters of the two groups were compared: WHVP (15.73±3.63) mmHg . (31.22±6.90) mmHg, <0.001; PVP (31.69±8.70) mmHg . (34.42±6.81) mmHg, <0.001; HVPG (7.18±4.40) mmHg . (19.40±6.62) mmHg, <0.001; PPG (24.24±8.11) mmHg . (25.34±6.60) mmHg, <0.001; free hepatic venous pressure (FHVP) (8.58±3.37) mmHg . (11.82±5.07) mmHg , <0.001; inferior vena cava pressure (IVCP) (7.45±3.29) mmHg . (9.09±4.14) mmHg, <0.001. The overall correlation is poor between HVPG and PPG. HVPG of most patients is not an accurate representation of PPG, and the former is lower than the latter. Hepatic venous collateral formation is one of the important reasons for the serious underestimation of HVPG values.
探讨门静脉高压症（PHT）患者门静脉压力梯度（PPG）与肝静脉压力梯度（HVPG）之间的相关性。分析2016年1月至2019年12月期间752例行经颈静脉肝内门体分流术（TIPS）且符合纳入标准的门静脉高压症（PHT）患者的肝静脉、下腔静脉及门静脉压力。采用配对t检验进行分析。采用Pearson相关检验估计相关系数和决定系数。P<0.05被认为具有统计学意义。肝静脉楔压（WHVP）、门静脉压力（PVP）、相关系数和决定系数分别为27.98±8.95 mmHg、33.85±7.33 mmHg、0.329（P<0.001）和0.108。肝静脉压力梯度（HVPG）、门静脉压力梯度（PPG）、相关系数和决定系数分别为16.84±7.97 mmHg、25.11±6.95 mmHg（P<0.001）、0.145和0.021（P<0.001）。524例患者的HVPG与PPG差值大于5 mmHg，占69.7%。228例患者的HVPG与PPG差值在5 mmHg以内或基本相等，占30.3%。游离肝静脉压力（FHVP）与下腔静脉压力（IVCP）的相关系数为0.568（P<0.001），决定系数为0.323。根据球囊闭塞肝静脉造影后门静脉侧支循环的有无，将患者分为两组：有肝静脉侧支循环组157例（20.9%），无肝静脉侧支循环组595例（79.1%）。比较两组参数：WHVP（15.73±3.63）mmHg对（31.22±6.90）mmHg，P<0.001；PVP（31.69±8.70）mmHg对（34.42±6.81）mmHg，P<0.001；HVPG（7.18±4.40）mmHg对（19.40±6.62）mmHg，P<0.001；PPG（24.24±8.11）mmHg对（25.34±6.60）mmHg，P<0.001；游离肝静脉压力（FHVP）（8.58±3.37）mmHg对（11.82±5.07）mmHg，P<0.
