Ma Li, Fang Ying, Zhang Wen, Liu Yaozu, Zhou Yongjie, Yu Jiaze, Zhou Xin, Zhang Zihan, Yang Minjie, Chen Shiyao, Wang Jian, Yan Zhiping, Luo Jianjun, Ma Jingqin
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Fudan University, Shanghai, China.
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Vasc Interv Radiol. 2025 Apr;36(4):625-634.e2. doi: 10.1016/j.jvir.2024.12.020. Epub 2024 Dec 20.
To evaluate the consistency and agreement between portal venous pressure measured by a fine needle (FN-PVP), direct portal vein catheterization (D-PVP), and wedged hepatic vein balloon occlusion (W-HVP) in patients with decompensated cirrhosis and intrahepatic venovenous shunts (IHVSs).
One hundred fifty-six consecutive patients planning to receive a transjugular intrahepatic portosystemic shunt in the authors' center were screened for study participation. The FN-PVP, D-PVP, and W-HVP were assessed for consistency by Pearson coefficient (r), linear regression coefficient (R), and intraclass correlation coefficient (ICC) and for disagreement (error exceeding 20% of D-PVP) by the Bland-Altman method.
Of 92 eligible patients, FN-PVP was successfully obtained in 37 (40.2%) with IHVS, with no puncture-related adverse events. In these patients, there were significant differences between W-HVP and D-PVP (-14.3 mm Hg; P < .001) with poor consistency (r = 0.410; R = 0.168; ICC, 0.105) but only minor differences between FN-PVP and D-PVP (-0.5 mm Hg; P = .134) with good consistency (r = 0.951; R = 0.904; ICC, 0.944). This pattern did not change when pressure gradients were compared (R = 0.083/0.767) and adjusted by stiffness measurements and platelet counts (R = 0.196/0.789). The W-HVP/D-PVP and FN-PVP/D-PVP disagreement occurred in 47.8% (34 with IHVS, 91.9%) and 0.0% of patients, respectively. In multivariate linear regression, only the presence of portal vein thrombosis (P = .045) was an independent predictor for the lower FN-PVP/D-PVP ratio. Portosystemic pressure gradient of FN-PVP showed greater ability to stratify that of D-PVP of 16 mm Hg (area under the curve, 1.000 vs 0.574; P < .001) and 20 mm Hg (0.974 vs 0.662; P = .001) than that of W-HVP.
FN-PVP measurement may be a valid and safe approach to reflect the severity of sinusoidal portal hypertension in patients with IHVS.
评估细针测量门静脉压力（FN-PVP）、直接门静脉置管（D-PVP）和肝静脉楔形球囊闭塞术（W-HVP）在失代偿期肝硬化合并肝内静脉分流（IHVS）患者中的一致性和相关性。
作者所在中心连续156例计划接受经颈静脉肝内门体分流术的患者被筛选纳入研究。通过Pearson系数（r）、线性回归系数（R）和组内相关系数（ICC）评估FN-PVP、D-PVP和W-HVP之间的一致性，并采用Bland-Altman方法评估差异（误差超过D-PVP的20%）。
92例符合条件的患者中，37例（40.2%）合并IHVS的患者成功获得FN-PVP，无穿刺相关不良事件。在这些患者中，W-HVP与D-PVP之间存在显著差异（-14.3 mmHg；P <.001），一致性较差（r = 0.410；R = 0.168；ICC，0.105），而FN-PVP与D-PVP之间差异较小（-0.5 mmHg；P =.134），一致性良好（r = 0.951；R = 0.904；ICC，0.944）。当比较压力梯度（R = 0.083/0.767）并通过硬度测量和血小板计数进行调整时（R = 0.196/0.789），这种模式没有改变。W-HVP/D-PVP和FN-PVP/D-PVP差异分别发生在47.8%（34例合并IHVS，91.9%）和0.0%的患者中。在多变量线性回归中，只有门静脉血栓形成的存在（P =.045）是FN-PVP/D-PVP比值较低的独立预测因素。FN-PVP的门体压力梯度比W-HVP更能区分D-PVP为16 mmHg时（曲线下面积，1.000对0.574；P <.001）和20 mmHg时（0.974对0.662；P =.001）的情况。
FN-PVP测量可能是反映IHVS患者窦性门静脉高压严重程度的一种有效且安全的方法。
