原发性肝癌患者肝静脉压力梯度与门静脉压力梯度相关性研究

The correlation between hepatic vein pressure gradient and portal vein pressure gradient in patients with primary liver cancer

目的 探讨原发性肝癌患者肝静脉压力梯度(hepatic vein pressure gradient, HVPG)与门静脉压力梯度(portal pressure gradient, PPG)相关性。方法 161例原发性肝癌患者在TIPS术中测量下腔静脉压力(inferior vena cava pressure,ICVP)、肝静脉自由压(free hepatic vein pressure, FHVP)、肝静脉楔压(wedged hepatic vein pressure, WHVP)和门静脉压力(portal vein pressure, PVP),计算HVPG(HVPG=WHVP-FHVP)和PPG(PPG=PVP-IVCP)。结果 161例患者HVPG为(20.18±9.22)mmHg,PPG为(26.44±6.82)mmHg,2者无相关性(r=0.112);PPG明显高于HVPG (P <0.05)。HVPG与PPG相差在5 mmHg以上者90例,占55.9%,HVPG与PPG相差在5 mmHg以内者71例,占44.1%。球囊阻断肝静脉造影有肝内静脉-静脉侧支分流(intrahepatic venous-venous collateral shunt, HVVC)者42例(26.09%),HVPG为(10.91±6.11)mmHg,PPG为(28.43±6.11)mmHg,2者呈弱相关(r=0.384);PPG显著高于HVPG(P <0.05)。球囊阻断肝静脉造影无HVVC者119例,HVPG为(23.45±7.81)mmHg,PPG为(25.74±6.94) mmHg,2者呈弱相关(r=0.249);PPG明显高于HVPG(P <0.05)。结论 原发性肝癌合并门静脉高压(portal hypertension, PHT)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;有HVVC形成是严重低估HVPG值的重要原因。

Objective To explore the correlation between hepatic vein pressure gradient(HVPG) and portal vein pressure gradient(PPG) in patients with primary liver cancer(PLC). Methods The inferior vena cava pressure(IVCP), hepatic venous free pressure(FHVP),hepatic venous wedge pressure(WHVP), and portal vein pressure(PVP) were measured during TIPS surgery in 161 patients with PLC, and the HVPG and PPG were calculated(HVPG=WHVP-FHVP, PPG=PVP-IVCP). Results Of all 161 patients, the mean HVPG and PPG were(20.18±9.22) and(26.44±6.82) mmHg, respectively. The correlation coefficient between HVPG and PPG was 0.112(P=0.156).The PPG was significantly higher than HVPG(t=6.929, P=0.001). 90(55.9%) cases had higher PPG than HVPG more than 5 mmHg, and 71(44.1%) cases had higher PPG than HVPG within 5 mmHg. A total of 42 cases received hepatic venography using balloon occlusion with intrahepatic venous-lateral branch shunt(HVVC), with mean HVPG, and PPG(10.91 ± 6.11) mmHg and(28.43 ± 6.11) mmHg respectively, the correlation coefficient between HVPG and PPG in 42 patients was 0.384(P=0.012). The PPG was significantly higher than that of HVPG(t=3.140, P=0.001). One hundred and nineteen cases received balloon occlusion blocking hepatic venography without HVVC,with mean HVPG and PPG(23.45±7.81) mmHg and(25.74±6.94) mmHg respectively, correlation coefficient between HVPG and PPG in 119 patients was 0.249(P=0.006) and the PPG was significantly higher than that of HVPG(t=2.393, P=0.017). Conclusions There is a limited correlation between HVPG and PPG in PLC patients, and HVPG is lower than PPG in most patients. The presence of HVVC is an important reason for this difference.