Vinel J P, Cassigneul J, Louis A, Levade M, Pascal J P
Surg Gynecol Obstet. 1982 Sep;155(3):347-52.
As the clinical significance of hemodynamic parameters remains controversial, the portohepatic gradient has been measured in 89 patients with cirrhosis by a transjugular approach. Relationships between portohepatic gradient and clinical, roentgenologic and prognostic patterns were studied with a maximum follow-up period of 36 months. Portohepatic gradient was not related to the rate of occurrence or rate of recurrence of digestive tract bleeding. Portohepatic gradient was related to the size of esophageal varices, p less than 0.01. Observation of large varices at endoscopy was associated with a higher risk of digestive tract bleeding. Portohepatic gradient was related to the number of portosystemic shunts opacified at portography, p less than 0.01. Portohepatic gradient was found to be related to these aspects of prognosis: the mean portohepatic gradient was higher in patients who died than it was in survivors, p less than 0.05. When patients were separated into two groups according to portohepatic gradient values--greater than or equal to 20.8, less than 20.8 millimeters of mercury--the actuarial survival rate was inversely related to portohepatic gradient at one, p less than 0.02, and at 12, p less than 0.02, months of follow-up study. This relationship could be demonstrated in the entire group of patients with cirrhosis and in the group of patients with digestive tract bleeding. This pattern seemed to be related to the risk of hemorrhage. In groups of patients and within a 24 month observation period, the survival rate was significantly related to the range of portohepatic gradient in each group.
由于血流动力学参数的临床意义仍存在争议，我们采用经颈静脉途径对89例肝硬化患者测量了肝门静脉梯度。研究了肝门静脉梯度与临床、放射学及预后模式之间的关系，最长随访期为36个月。肝门静脉梯度与消化道出血的发生率或复发率无关。肝门静脉梯度与食管静脉曲张的大小有关，P<0.01。内镜检查发现大静脉曲张与消化道出血风险较高相关。肝门静脉梯度与门静脉造影显示的门体分流数量有关，P<0.01。发现肝门静脉梯度与以下预后方面有关：死亡患者的平均肝门静脉梯度高于存活患者，P<0.05。根据肝门静脉梯度值（大于或等于20.8、小于20.8毫米汞柱）将患者分为两组，在随访研究的1个月时，P<0.02，以及12个月时，P<0.02，精算生存率与肝门静脉梯度呈负相关。这种关系在整个肝硬化患者组和消化道出血患者组中均得到证实。这种模式似乎与出血风险有关。在患者组中以及在24个月的观察期内，生存率与每组肝门静脉梯度范围显著相关。
