门静脉高压患者肝静脉压力梯度与门静脉压相关性及其临床价值

The agreement and clinical value of hepatic vein pressure gradient and portal vein pressure in patients with portal hypertension

目的 探讨门静脉高压患者肝静脉压力梯度与门静脉压的相关性及其临床价值. 方法 经颈静脉肝内门体静脉分流术（TIPS）用球囊导管、压力传感器及测压仪测定46例患者的肝静脉楔压、自由压,及穿刺门静脉成功后分流道建立前、后门静脉压.Spearman＇s rank test分析肝静脉压力梯度与门静脉压的相关性. 结果 46例患者中,5例患者肝静脉压力梯度与门静脉压无相关性,门静脉造影检查显示其中3例患者肝内有明显的交通支直接分流道至肝段下腔静脉（即第三肝门静脉形成）,另外2例患者明显脐静脉开放.41位患者纳入相关性分析结果显示,肝静脉压力梯度与门静脉压呈正相关（r=0.57,P＜0.001）.急诊TIPS组的肝静脉压力梯度及门静脉压分别为（24.1±3.1） mmHg、（28.7±3.1） mmHg,与非急诊TIPS组的（23.5±4.1） mmHg和（31.4±4.9） mmHg比较,P值均＞0.05,差异无统计学意义.TIPS分流后,门静脉压为（17.1±4.7） mmHg,与分流前的（30.7±4.5）mmHg比较,显著降低,P＜ 0.001,差异有统计学意义.结论 对绝大多数门静脉高压患者肝静脉压力梯度与门静脉压呈正相关,临床上可用肝静脉压力梯度反映门静脉压.

Objective To evaluate the agreement and correlation between hepatic vein pressure gradient （HVPG） and portal vein pressure （PVP） in patients with portal hypertension,and explore their clinical value.Methods A total of 46 patients with portal hypertension were directly measured the free hepatic pressure,wedged hepatic pressure,portal vein pressure before and after TIPS therapy.The agreement and correlation of HVPG and PVP were analyzed,and explore their clinical value.Results There is no significant agreement or correlation between HVPG and PVP in 5 patients,whose third hilar have large communicating branches between portal vein and Inferior vena cava,or with obvious umbilical vein opened.The HVPGs were significantly agreed with portal vein pressure in other 41 patients.There is no significant difference of HVPG or PVP between earlyTIPS and not early-TIPS groups.In addition,the portal vein pressures after TIPS were significantly decreased compared with that before TIPS.Conclusion The HVPG can well show the PVP except these with obvious communicating branches between portal vein and Inferior vena cava in third hilar,and TIPS can effectively decrease the portal vein pressure in patients with portal hypertension.