Merkel C, Sacerdoti D, Bolognesi M, Bombonato G, Gatta A
Department of Clinical and Experimental Medicine, University of Padua, Padova, Italy.
J Hepatol. 1998 Apr;28(4):622-30. doi: 10.1016/s0168-8278(98)80286-9.
BACKGROUND/AIM: The study was designed to assess to what extent portal hemodynamic parameters obtained by duplex Doppler ultrasonography may be substituted for the measurement of hepatic venous pressure gradient in evaluating the severity of portal hypertension and the response to medical treatment with beta-blockers or beta-blockers plus nitrates in patients with cirrhosis and portal hypertension.
In 39 of these patients hepatic venous pressure gradient was determined by hepatic vein catheterization, and portal blood flow velocity and the congestion index of the portal vein were measured by duplex Doppler ultrasonography. In 19 of these patients the changes in hepatic venous pressure gradient and in Doppler parameters were also assessed after chronic administration of nadolol. In 11 of the 19 patients the changes after chronic administration of nadolol plus isosorbide-5-mononitrate were also measured.
In the whole series, no significant correlation was found between hepatic venous pressure gradient and duplex Doppler parameters, but, when the 12 patients with a patent para-umbilical vein were excluded, significant linear correlations were found between hepatic venous pressure gradient and portal blood velocity (r=-0.39; p=0.05) or congestion index (r=0.37; p=0.05). Considering together the changes induced by nadolol and nadolol plus isosorbide-5-mononitrate, no correlation was apparent between changes in duplex Doppler parameters and in hepatic venous pressure gradient. Agreement between hepatic venous pressure gradient and duplex Doppler parameters in defining good and poor responders was insufficient.
These data suggest that portal blood velocity and the congestion index of the portal vein are related to portal hypertension in patients without a patent para-umbilical vein, but are of limited value in discriminating good responders from poor responders to medical treatment for portal hypertension.
背景/目的：本研究旨在评估在评估肝硬化和门静脉高压患者门静脉高压的严重程度以及对β受体阻滞剂或β受体阻滞剂加硝酸盐药物治疗的反应时，经双功多普勒超声获得的门静脉血流动力学参数可在多大程度上替代肝静脉压力梯度的测量。
在其中39例患者中，通过肝静脉插管测定肝静脉压力梯度，并通过双功多普勒超声测量门静脉血流速度和门静脉充血指数。在其中19例患者中，还评估了长期服用纳多洛尔后肝静脉压力梯度和多普勒参数的变化。在这19例患者中的11例中，还测量了长期服用纳多洛尔加5-单硝酸异山梨酯后的变化。
在整个系列中，未发现肝静脉压力梯度与双功多普勒参数之间存在显著相关性，但排除12例脐旁静脉通畅的患者后，发现肝静脉压力梯度与门静脉血流速度（r = -0.39；p = 0.05）或充血指数（r = 0.37；p = 0.05）之间存在显著线性相关性。综合考虑纳多洛尔和纳多洛尔加5-单硝酸异山梨酯引起的变化，双功多普勒参数的变化与肝静脉压力梯度的变化之间无明显相关性。肝静脉压力梯度与双功多普勒参数在定义反应良好和反应不佳者方面的一致性不足。
这些数据表明，在脐旁静脉不通畅的患者中，门静脉血流速度和门静脉充血指数与门静脉高压有关，但在区分门静脉高压药物治疗的反应良好者和反应不佳者方面价值有限。
