放射性核素显像与肝静脉楔入压测定预测门静脉压力的比较与临床意义

Calculation of portal pressure by radionuclide imaging as compared with measurement of wedged hepatic vein pressure and its clinical application

目的比较应用放射性核素显像法与肝静脉楔入压测定法推测门静脉压力的准确性及临床意义。方法应用经直肠一次性注入９９ｍＴｃ甲氧基异丁基异腈７５０ｍＢｑ后行放射性核素显像的方法测定８１例肝硬变门静脉高压症病人和无肝硬变对照组２３例病人的心脏与肝脏的放射性比值（Ｈ／Ｌ），并测定肝硬变门静脉高压症病人７１例肝静脉楔入压（ＷＨＶＰ）。测得的Ｈ／Ｌ经回归方程Ｙ（ｃｍＨ２Ｏ）＝１０＋２９Ｈ／Ｌ推算出门静脉压力（Ｈ／ＬＰＶＰ）。所有病人均行开腹手术，开腹后立即测定门静脉压力（ＰＶＰ）并分别与手术前Ｈ／ＬＰＶＰ和ＷＨＶＰ测定值相比较。结果８１例门静脉高压症病人开腹手术中实测ＰＶＰ值（３５±７）ｃｍＨ２Ｏ与术前经Ｈ／ＬＰＶＰ公式推算值（３５±６）ｃｍＨ２Ｏ两者非常接近，具有明显的相关性（ｒ＝０９１，Ｐ＜０００１），而无肝病对照组ＰＶＰ（１８±４）ｃｍＨ２Ｏ与Ｈ／ＬＰＶＰ（１８±４）ｃｍＨ２Ｏ也呈明显的相关性（ｒ＝０８９，Ｐ＜０００１）；７１例门静脉高压症病人术中实测ＰＶＰ（３７±６）ｃｍＨ２Ｏ与术前ＷＨＶＰ（３８±８）ｃｍＨ２Ｏ也呈明显正相关（ｒ＝０７８，Ｐ＜０００１）。结论Ｈ／ＬＰＶＰ同ＷＨＶＰ一样可以真?

Objective To evaluate the accuracy of radionuclide imaging in the prediction of portal vein pressure v.s. wedged hepatic vein pressure and its clinical application.Methods The radionuclide imaging was performed and the heart over liver (H/L) ratio calculated after 99m Tc methoxyl isobuty isonitrise (MIBI) in a bolus dosage of 750 mBq was given per rectum in 81 cirrhotic patients with portal hypertension and 23 “noncirrhotic healthy” controls, and wedged hepatic vein pressure (WHVP) was also measured in 71 cirrhotic patients with portal hypertension. The portal vein pressure was calculated by thus established regressional equation of Y (cmH 2O)=10+29 H/L (H/L PVP).All patients underwent laparotomy afterwards.Portal vein pressure (PVP) was measured at the operation directly and the value was compared with that by preoperative H/L PVP and WHVP.Results PVP in cirrhotic patients with portal hypertension of (35±7) cmH 2O was very close and positively correlated to H/L PVP of (35±6) cmH 2O ( r =0 91, P <0 01 );and also in the controls PVP of (18±4) cmH 2O to H/L PVP of (18±4) cmH 2O( r =0 89, P <0 01) The PVP of (37±6) cmH 2O was very close and positively correlated to the WHVP of (38±8) cmH 2O ( r =0 78, P <0 01).Conclusions The results showed that H/L PVP is as accurate as WHVP for the determination of PVP, and also it is a nontraumatic, accurate,reproducible method both for the diagnosis of portal hypertension and for the determination of PVP in a given patient.