Le Moine O, Hadengue A, Moreau R, Sogni P, Soupison T, Yang S, Hartleb M, Lebrec D
Laboratory for Splanclinic Hemodynamics and Vascular Biology, Hôpital Beaujon, Clichy, France.
Scand J Gastroenterol. 1997 Jul;32(7):731-5. doi: 10.3109/00365529708996526.
Hepatic venous pressure gradient, esophageal varices, and variceal bleeding were investigated in 957 patients with cirrhosis. The causes (alcoholic/virus) and stage (Child-Pugh's classification) of cirrhosis were also taken into account.
The prevalence of variceal bleeding was 35% in patients with large varices and 17% in those with small varices (P < 0.05). It was higher in patients with alcoholic cirrhosis (41% and 19%, respectively) than in those with viral cirrhosis (22% and 10%, respectively). In patients with alcoholic cirrhosis the hepatic venous pressure gradient was higher in Child A and B patients with small or large varices than in those with no varices; these differences were not found in Child C patients and in patients with viral cirrhosis. In all subgroups the pressure gradient was higher in Child C patients than in Child A patients. There was no significant difference in the hepatic venous pressure gradient between patients with varices and previous variceal bleeding and those with no bleeding whatever the stage of cirrhosis.
This study shows that the hepatic venous pressure gradient is associated with the stage and causes of cirrhosis and the presence of varices. These factors should be taken into account in studies evaluating the hepatic venous pressure gradient in heterogeneous groups of patients.
对957例肝硬化患者的肝静脉压力梯度、食管静脉曲张及曲张静脉出血情况进行了研究。同时也考虑了肝硬化的病因（酒精性/病毒性）和分期（Child-Pugh分级）。
大静脉曲张患者曲张静脉出血的发生率为35%，小静脉曲张患者为17%（P<0.05）。酒精性肝硬化患者的发生率（分别为41%和19%）高于病毒性肝硬化患者（分别为22%和10%）。在酒精性肝硬化患者中，Child A和B级有小或大静脉曲张的患者肝静脉压力梯度高于无静脉曲张者；在Child C级患者和病毒性肝硬化患者中未发现这些差异。在所有亚组中，Child C级患者的压力梯度高于Child A级患者。无论肝硬化处于何阶段，有静脉曲张及既往有曲张静脉出血的患者与无出血患者的肝静脉压力梯度均无显著差异。
本研究表明，肝静脉压力梯度与肝硬化的分期、病因及静脉曲张的存在有关。在评估不同患者群体的肝静脉压力梯度的研究中应考虑这些因素。
