Liver Disease Minimally Invasive Diagnosis and Treatment Center, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tie Yi Road, Yangfangdian, Haidian District, Beijing, 100038, China.
Liver Vascular Disease Diagnosis and Treatment Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.
Sci Rep. 2024 Nov 25;14(1):29210. doi: 10.1038/s41598-024-80870-9.
To evaluate the differences in the agreement between wedged hepatic venous pressure (WHVP) and portal venous pressure (PVP) at different hepatic venous pressure gradient (HVPG) levels to identify specific HVPG thresholds where WHVP can reliably estimate PVP, thus enhancing the accuracy of risk stratification and treatment decision-making for portal hypertension (PHT) patients. A multicenter study of 616 patients with PHT from three centers was stratified into five groups by their HVPG: HVPG < 12 (group A), 12 ≤ HVPG < 16 mmHg (group B), 16 ≤ HVPG < 20 mmHg (group C), 20 ≤ HVPG < 24 mmHg (group D), HVPG ≥ 24 mmHg (group E). Concordance was analyzed using Pearson's correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis in each HVPG stratum. Correlation and agreement between WHVP and PVP varied by HVPG group. Highest agreement was observed in the range of 20 ≤ HVPG < 24 mmHg. (R = 0.55, ICC = 0.68). The proportion of patients with a discrepancy between WHVP and PVP that was greater than 10% of the PVP value was highest in group A (95.7%) and lowest in group D (48.4%). Overestimation of PVP was more common in group E (44.5%), and underestimation of PVP was more common in group A (94.6%). This study does not confirm the usefulness of hepatic vein pressure measurements to predict the PVP and PPG. The means of WHVP and PVP were significantly different in ranges A, B, C, and E.
为了评估在不同肝静脉压力梯度 (HVPG) 水平下楔形肝静脉压 (WHVP) 和门静脉压 (PVP) 之间的一致性差异，以确定 WHVP 能够可靠估计 PVP 的特定 HVPG 阈值，从而提高门静脉高压 (PHT) 患者的风险分层和治疗决策的准确性。这项多中心研究纳入了来自三个中心的 616 名 PHT 患者，根据 HVPG 将其分为五组：HVPG<12mmHg（A 组）、12mmHg≤HVPG<16mmHg（B 组）、16mmHg≤HVPG<20mmHg（C 组）、20mmHg≤HVPG<24mmHg（D 组）、HVPG≥24mmHg（E 组）。在每个 HVPG 分层中，使用 Pearson 相关系数 (R)、组内相关系数 (ICC) 和 Bland-Altman 分析来分析一致性。WHVP 和 PVP 之间的相关性和一致性因 HVPG 组而异。在 20mmHg≤HVPG<24mmHg 的范围内观察到最高的一致性 (R=0.55，ICC=0.68)。WHVP 和 PVP 之间差异大于 PVP 值的 10%的患者比例在 A 组最高（95.7%），在 D 组最低（48.4%）。在 E 组中，PVP 的高估更为常见（44.5%），而在 A 组中，PVP 的低估更为常见（94.6%）。这项研究并不能证实肝静脉压力测量对预测 PVP 和 PPG 的有用性。WHVP 和 PVP 的平均值在 A、B、C 和 E 组中差异显著。
