Imai Yusuke, Koizumi Yohei, Hiasa Yoichi, Hirooka Masashi, Tokumoto Yoshio, Yoshida Osamu, Chikamori Fumio
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan.
Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminami-Machi, Kochi City, Kochi, 780-8562, Japan.
J Gastroenterol. 2025 Jan;60(1):24-31. doi: 10.1007/s00535-024-02182-z. Epub 2024 Dec 9.
Direct measurement of portal venous pressure (PVP) is invasive, so the hepatic venous pressure gradient (HVPG) is commonly measured to evaluate portal hypertension (PH). HVPG is the gold standard for estimating PVP but few reports have covered standardized measurement techniques.
This study validated standardized techniques for PVP measurement.
In Western countries, electronic transducers are commonly used to measure PVP, whereas the water column method is still frequently applied in Japan. Setting a reference point for accurate PVP measurement is important but complicated. According to Japanese guidelines, the reference point for PVP measurement is 10 cm above the dorsal surface or in the midaxillary line. For simpler determination, the anterior axillary point, defined as the point of convergence between the proximal pectoralis major muscle and arm when both arms are positioned against the trunk in a supine position, can be used as the reference point. New methods, such as endoscopic ultrasound-guided portal pressure gradient, offer less invasive alternatives. Non-invasive methods like elastography measure liver and spleen stiffness, which correlate with HVPG. The Baveno VII criteria incorporate measurements of liver and splenic stiffness for risk stratification. Biomarkers such as type IV collagen, M2BPGi, and FIB-4 score also predict HVPG. The Baveno VII consensus emphasizes the status of HVPG as the gold standard while advocating for non-invasive alternative methods to improve patient care and monitor treatment efficacy.
Continued development of non-invasive tests is crucial for safer, more convenient PH management.
门静脉压力（PVP）的直接测量具有侵入性，因此通常测量肝静脉压力梯度（HVPG）来评估门静脉高压（PH）。HVPG是估计PVP的金标准，但很少有报告涉及标准化测量技术。
本研究验证了PVP测量的标准化技术。
在西方国家，电子换能器常用于测量PVP，而水柱法在日本仍经常使用。为准确测量PVP设置参考点很重要但很复杂。根据日本指南，PVP测量的参考点是背侧表面上方10厘米处或腋中线处。为了更简单地确定，可以将前腋点用作参考点，前腋点定义为仰卧位双臂靠在躯干上时胸大肌近端与手臂之间的交汇点。新方法，如内镜超声引导的门静脉压力梯度，提供了侵入性较小的替代方法。像弹性成像这样的非侵入性方法测量肝脏和脾脏硬度，这与HVPG相关。巴韦诺VII标准纳入了肝脏和脾脏硬度测量以进行风险分层。IV型胶原、M2BPGi和FIB-4评分等生物标志物也可预测HVPG。巴韦诺VII共识强调HVPG作为金标准的地位，同时提倡使用非侵入性替代方法来改善患者护理和监测治疗效果。
持续开发非侵入性检测对于更安全、更方便地管理PH至关重要。
