肝硬化门静脉高压患者肝静脉压力梯度的影响因素分析

周昊; 姚欣; 汤善宏; 冯志松; 何苹苹; 尹琴琴; 李运明; 秦建平

doi:10.3969/j.issn.1001-5256.2019.10.015

肝硬化门静脉高压患者肝静脉压力梯度的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2019.10.015

1. 中国人民解放军西部战区总医院消化内科
2. 川北医学院
3. 川北医学院附属医院消化内科
4. 中国人民解放军西部战区总医院放射科
5. 中国人民解放军西部战区总医院信息科

基金项目:

原成都军区总医院基金项目(2013YG-B009)；

详细信息

中图分类号: R575.2
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- 被引次数: 12
出版历程
- 收稿日期: 2019-06-03
- 出版日期: 2019-10-20

Influencing factors for hepatic venous pressure gradient in patients with cirrhotic portal hypertension

Department of Gastroenterology,The General Hospital of Western Theater Command of the Chinese PLA

Research funding:

摘要

摘要: 目的探讨行经颈静脉肝内门体静脉分流术（TIPS）治疗的肝硬化门静脉高压患者肝静脉压力梯度（HVPG）的临床影响因素。方法选取2015年1月-2018年12月在中国人民解放军西部战区总医院接受TIPS治疗的肝硬化门静脉高压患者158例。在TIPS过程中,分别测量肝静脉楔压、肝静脉自由压及门静脉压,计算得出HVPG与门静脉压力梯度（PVPG）。计量资料2组间比较采用t检验,多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。HVPG与PVPG相关性采用Pearson相关分析,采用多元线性逐步回归法分析影响HVPG的独立危险因素。结果 HVPG与PVPG呈正相关（r=0. 796,P <0. 001）。单因素方差分析显示年龄、病因是HVPG的影响因素（F值分别为19. 900、10. 287,P值均<0. 001）。多元线性逐步回归分析显示,年龄及病因是HVPG的独立影响因素（t值分别为7. 870、-2. 178,P值均<0. 001）。结论肝硬化门静脉高压患者的年龄和病因是HVPG的独立影响因素,年龄≥60岁或慢性丙型肝炎肝硬化门静脉高压患者具有更高的HVP...
- 门体分流术,经颈静脉肝内 /
- 肝硬化 /
- 高血压,门静脉 /
- 危险因素
Abstract: Objective To investigate the influencing factors for hepatic venous pressure gradient(HVPG) in patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt(TIPS). Methods A total of 158 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command of the Chinese PLA from January 2015 to December 2018 were enrolled. Wedged hepatic venous pressure(WHVP),free hepatic venous pressure(FHVP),and portal venous pressure(PVP) were measured during TIPS,and HVPG and portal venous pressure gradient(PVPG) were calculated. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. The Pearson correlation coefficient was used to analyze the correlation between HVPG and PVPG,and a multivariate linear stepwise regression analysis was used to investigate the independent risk factors for HVPG. Results HVPG was positively correlated with PVPG(r = 0. 796,P < 0. 001). The one-way analysis of variance showed that age and etiology were influencing factors for HVPG(F = 19. 900 and 10. 287,both P < 0. 001). The multivariate linear stepwise regression analysis showed that age and etiology were independent influencing factors for HVPG(t = 7. 870 and-2. 178,both P < 0. 001). Conclusion Age and etiology are independent influencing factors for HVPG in patients with cirrhotic portal hypertension,and the patients aged ≥60 years or the patients with hepatitis C virus-related cirrhosis tend to have higher HVPG.
- portasystemic shunt,transjugular intrahepatic /
- liver cirrhosis /
- hypertension,portal /
- risk factors

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参考文献(24)

[1] BOSCH J,IWAKIRI Y. The portal hypertension syndrome:Etiology,classification,relevance,and animal models[J]. Hepatol Int,2017,12(4):1-10.

[2] BOSCH J,ABRALDES JG,BERZIGOTTI A,et al. The clinical use of HVPG measurements in chronic liver disease[J]. Nat Rev Gastroenterol Hepatol,2009,6(10):573-582.

[3] THALHEIMER U,LEANDRO G,SAMONAKIS DN,et al. Assessment of the agreement between wedge hepatic vein pressure and portal vein pressure in cirrhotic patients[J]. Dig Liver Dis,2005,37(8):601-608.

[4] DING HG,XU XY,LINGHU EQ,et al. Interpretation of guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):220-222.(in Chinese)丁惠国,徐小元,令狐恩强,等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].临床肝胆病杂志,2016,32(2):220-222.

[5] Group of Gastrointestinal Intervention,Chinese Society of Gastroenterology, Chinese Medical Association. Consensus on transjugular intrahepatic portosystemic shunt for treatment of cirrhotic portal hypertension[J]. J Clin Hepatol,2014,30(3):210-213.(in Chinese)中华医学会消化病学分会消化介入学组.经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见[J].临床肝胆病杂志,2014,30(3):210-213.

[6] THOMAS DB,HASKAL ZJ. The role of transjugular intrahepatic portosystemic shunt(TIPS)in the management of portal hypertension:Update 2009[J]. Hepatology,2010,51(1):386-400.

[7] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterolory,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.

[8] Chinese Society of Hepatology,Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol,2017,33(10):1847-1863.(in Chinese)中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,33(10):1847-1863.

[9] TANG SH,QIN JP,JIANG MD,et al. The agreement and clinical value of hepatic vein pressure gradient and portal vein pressure in patients with portal hypertension[J]. Chin J Hepatol,2015,23(5):354-357.(in Chinese)汤善宏,秦建平,蒋明德,等.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[J].中华肝脏病杂志,2015,23(5):354-357.

[10] BOSCH J,GARCIAPAGAN JC,BERZIGOTTI A,et al. Measurement of portal pressure and its role in the management of chronic liver disease[J]. Semin Liver Dis,2006,26(4):348-362.

[11] QIN JP,TANG W,TANG SH,et al. Modified tranjugular intrahepatic portosystemic shunt in the treatment of portal hypertension of liver cirrhosis[J]. Chin J Dig,2014,34(1):33-36.(in Chinese)秦建平,唐文,汤善宏,等.改良经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压症[J].中华消化杂志,2014,34(1):33-36.

[12] QIN JP,JIANG MD,TANG W,et al. Clinical effects and complications of TIPS for portal hypertension due to cirrhosis:A single center[J]. World J Gastroenterol,2013,19(44):8085-8092.

[13] ZHANG M,ZHUGE YZ,ZOU XP,et al. Correlation between hepatic venous pressure gradient and clinic features in patients with liver cirrhosis[J]. Chin J Dig,2015,35(8):530-533.(in Chinese)张明,诸葛宇征,邹晓平,等.肝静脉压力梯度与肝硬化患者临床特征的相关性[J].中华消化杂志,2015,35(8):530-533.

[14] BELLIS LR,MONTAGNESE F,FESTUCCIA F,et al. Hepatic venous pressure gradient determination in patients with hepatitis C virus-related and alcoholic cirrhosis[J]. Eur J Gastroenterol Hepatol,2003,15(10):1085-1089.

[15] WADHAWAN M,DUBEY S,SHARMA BC,et al. Hepatic venous pressure gradient in cirrhosis:Correlation with the size of varices,bleeding,ascites,and child’s status[J]. Dig Dis Sci,2006,51(12):2264-2269.

[16] GULZAR GM,ZARGAR SA,JALAL S,et al. Correlation of hepatic venous pressure gradient with variceal bleeding,size of esophageal varices,etiology,ascites and degree of liver dysfunction in cirrhosis of liver[J]. Indian J Gastroenterol,2009,28(2):59-61.

[17] SUBRAMANIAM R,NIRANJAN K,NAVEEN K,et al. Correlation of HVPG level with CTP score,MELD score,ascites,size of varices,and etiology in cirrhotic patients[J]. Saudi J Gastroenterol,2016,22(2):109-115

[18] MAMUN AM,SHEIKH MNEA,MOHAMMAD AR,et al. Hepatic venous pressure gradient measurement in bangladeshi cirrhotic patients:A correlation with Child’s status,variceal size,and bleeding[J]. Euroasian J Hepatogastroenterol,2017,7(2):142-145.

[19] XU R,CHANG J,HUANG H,et al. Relationship between clinical parameters and degree of liver fibrosis and risk factors for significant liver fibrosis in patients with chronic hepatitis B:A Logistic regression analysis[J]. World Chin J Dig,2016,24(2):279-286.(in Chinese)徐瑞,常江,黄华,等.慢性乙型肝炎患者临床指标与肝脏纤维化程度关系及明显肝纤维化危险因素的Logistic回归分析[J].世界华人消化杂志,2016,24(2):279-286.

[20] WESTBROOK RH,DUSHEIKO G. Natural history of hepatitis C[J]. J Hepatol,2014,61(1):s58-s68.

[21] RASTOGI A,MAIWALL R,BIHARI C,et al. Cirrhosis histology and Laennec staging system correlate with high portal pressure[J]. Histopathology,2013,62(5):731-741.

[22] VINCENT JK,STARK C,SHIELDS JT,et al. Hepatic venous pressure gradient correlates with advanced hepatic fibrosis:A retrospective review[J]. Abdom Radiol(NY),2017,42(11):2609-2614.

[23] LU LG. Current understanding of the process of liver fibrosis in chronic liver disease[J]. J Diagn Concepts Pract,2005,4(1):9-11.(in Chinese)陆伦根.慢性肝病肝纤维化进程的现今认识[J].诊断学理论与实践,2005,4(1):9-11.

[24] Chinese Portal Hypertension Diagnosis and Monitoring Study Group(CHESS); Minimally Invasive Intervention Collaborative Group,Chinese Society of Gastroenterology; Emergency Intervention Committee,Chinese College of Interventionalists,et al. Consensus on clinical application of hepatic venous pressure gradient in China(2018)[J]. J Clin Hepatol,2018,34(12):2526-2536.(in Chinese)中国门静脉高压诊断与监测研究组(CHESS),中华医学会消化病学分会微创介入协作组,中国医师协会介入医师分会急诊介入专业委员会,等.中国肝静脉压力梯度临床应用专家共识(2018版)[J].临床肝胆病杂志,2018,34(12):2526-2536.

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