门静脉高压患者PPG与HVPG相关性研究

Study on the correlation between PPG and HVPG in patients with portal hypertension

目的探讨门静脉高压(PHT)患者门静脉压力梯度(PPG)与肝静脉压力梯度(HVPG)相关性。方法2016年1月-2019年12月符合入组标准的752例PHT患者在经颈静脉肝内门体静脉分流术(TIPS)术中获得的肝静脉、下腔静脉及门静脉压力进行分析。采用配对t检验进行分析,相关性采用Pearson相关性检验进行分析,估计相关系数和决定系数。P<0.05为差异有统计学意义。结果肝静脉楔压(WHVP)为(27.98±8.95)mmHg,门静脉压(PVP)为(33.85±7.33)mmHg,其相关系数为0.329(P<0.001),决定系数为0.108。HVPG为(16.84±7.97)mmHg,PPG为(25.11±6.95)mmHg(P<0.001),其相关性系数为0.145,决定系数为0.021(P<0.001),HVPG与PPG相差在5 mmHg以上524例,占69.7%,HVPG与PPG相差在5 mmHg以内或基本相等228例,占30.3%。肝静脉游离压(FHVP)与下腔静脉压(IVCP)的相关性系数为0.568(P<0.001),决定系数为0.323。根据球囊阻断肝静脉造影后是否有肝静脉侧支分为两组,有肝静脉侧支组共157例(20.9%),无肝静脉侧支组共595例(79.1%),两组各参数比较:WHVP为(15.73±3.63)mmHg对比(31.22±6.90)mmHg,P<0.001;PVP为(31.69±8.70)mmHg对比(34.42±6.81)mmHg,P<0.001;HVPG(7.18±4.40)mmHg对比(19.40±6.62)mmHg,P<0.001;PPG(24.24±8.11)mmHg对比(25.34±6.60)mmHg,P<0.001;肝静脉游离压(FHVP)为(8.58±3.37)mmHg对比(11.82±5.07)mmHg,P<0.001;下腔静脉压力(IVCP)为(7.45±3.29)mmHg对比(9.09±4.14)mmHg,P<0.001。结论HVPG与PPG总体相关性差,大部分患者的HVPG不能准确代表PPG,并且前者低于后者;肝静脉侧支形成是严重低估HVPG值的重要原因之一。

Objective To explore the correlation between portal vein pressure gradient(PPG)and hepatic vein pressure gradient(HVPG)in patients with portal hypertension(PHT).Methods 752 cases with portal hypertension(PHT)who underwent transjugular intrahepatic portosystemic shunt(TIPS)and met the enrollment criteria between January 2016 to December 2019 were analyzed for hepatic vein,inferior vena cava and portal vein pressure.Paired t-test was used for analysis.Pearson correlation test was used to estimate correlation coefficient and coefficient of determination.P<0.05 were considered statistically significant.Results Wedged hepatic vein pressure(WHVP),portal vein pressure(PVP),correlation coefficient,and coefficient of determination were 27.98±8.95 mmHg,33.85±7.33 mmHg,0.329(P<0.001),and 0.108,respectively.HVPG,PPG,correlation coefficient,and coefficient of determination were 16.84±7.97 mmHg,25.11±6.95 mmHg(P<0.001),0.145,and 0.021(P<0.001),respectively.The difference between HVPG and PPG was greater than 5 mmHg in 524 cases,accounting for 69.7%.The difference between HVPG and PPG was within 5 mmHg or basically equal in 228 cases,accounting for 30.3%.The correlation coefficient between free hepatic venous pressure(FHVP)and inferior vena cava pressure(IVCP)was 0.568(P<0.001),and the coefficient of determination was 0.323.According to the presence or absence of hepatic venous collaterals after balloon occluded hepatic angiography,they were divided into two groups:157(20.9%)cases in the group with hepatic venous collaterals,and 595(79.1%)cases in the group without hepatic venous collaterals.The parameters of the two groups were compared:WHVP(15.73±3.63)mmHg vs.(31.22±6.90)mmHg,P<0.001;PVP(31.69±8.70)mmHg vs.(34.42±6.81)mmHg,P<0.001;HVPG(7.18±4.40)mmHg vs.(19.40±6.62)mmHg,P<0.001;PPG(24.24±8.11)mmHg vs.(25.34±6.60)mmHg,P<0.001;free hepatic venous pressure(FHVP)(8.58±3.37)mmHg vs.(11.82±5.07)mmHg,P<0.001;inferior vena cava pressure(IVCP)(7.45±3.29)mmHg vs.(9.09±4.14)mmHg,P<0.001.Conclusion The overall correlation is poor between HVPG and PPG.HVPG of most patients is not an accurate representation of PPG,and the former is lower than the latter.Hepatic venous collateral formation is one of the important reasons for the serious underestimation of HVPG values.