吡咯生物碱相关肝窦阻塞综合征68例肝静脉压力梯度与多普勒超声参数的关系  

Relationship between hepatic venous pressure gradient and parameters of Doppler ultrasound in 68 patients with pyrroidine alkaloid-related hepatic sinusoidal obstruction syndrome

作　　者：蔡子豪 肖江强[1] 张明[1] 张峰[1] 张玮[1] 殷芹[1] 韩浩[2] 诸葛宇征[1] Cai Zihao;Xiao Jiangqiang;Zhang Ming;Zhang Feng;Zhang Wei;Yin Qin;Han Hao;Zhuge Yuzheng(Department of Gastroenterology,Drum Tower Hospital,Affiliated Medical College of Nanjing University,Nanjing210000,China;Department of Ultrasound,Drum Tower Hospital,Affiliated Medical College of Nanjing University,Nanjing 210000,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210000 [2]南京大学医学院附属鼓楼医院超声医学科,南京210000

出　　处：《中华消化杂志》2022年第9期589-595,共7页Chinese Journal of Digestion

基　　金：国家自然科学基金青年科学基金项目 (82100652)。

摘　　要：目的探究吡咯生物碱(PA)相关肝窦阻塞综合征(PA-HSOS)患者的肝静脉压力梯度(HVPG)与多普勒超声参数的关系。方法回顾性分析2017年2月17日至2020年4月22日至南京大学医学院附属鼓楼医院就诊的68例行HVPG检测和多普勒超声检查的PA-HSOS患者的临床资料[包括HVPG、鼓楼严重度评分(DTSS)、进食PA后出现PA-HSOS相关症状至确诊时间(以下简称确诊时间)等]和多普勒超声参数[门静脉主干内径(PD)、峰值门静脉流速(PPV)、脾静脉主干内径(SD)、峰值脾静脉流速(PSV)]。绘制受试者操作特征曲线(ROC)确定HVPG预测抗凝无应答的最佳截断值,采用二元logistic回归分析抗凝无应答的独立危险因素,采用Kaplan-Meier生存曲线分析不同HVPG的PA-HSOS患者的预后生存率,采用一元线性回归分析不同HVPG患者,DTSS轻、中、重度患者,以及确诊时间>1个月与≤1个月患者的HVPG与PD、PPV、SD、PSV的相关性。统计学方法采用卡方检验。结果ROC分析显示,HVPG预测抗凝治疗无应答的最佳截断值为20.165 mmHg(1 mmHg=0.133 kPa)。多因素分析显示高HVPG(HVPG>20.165 mmHg)是预测抗凝治疗无应答的独立危险因素[OR(95%置信区间)=6.039(1.466~24.869),P=0.013]。Kaplan-Meier生存曲线显示高HVPG患者预后生存率低于低HVPG(HVPG≤20.165 mmHg)患者(78.4%比96.8%),差异有统计学意义(χ^(2)=4.74,P=0.030)。一元线性回归分析显示,68例PA-HSOS患者的HVPG与PPV呈负相关(r=-0.330,P=0.006);高HVPG患者的HVPG与PD、SD均呈正相关(r=0.540、0.341,P=0.001、0.039);DTSS轻度患者的HVPG与PSV呈负相关(r=-0.519,P=0.019);DTSS中度患者的HVPG与PPV呈负相关(r=-0.400,P=0.014);确诊时间≤1个月患者的HVPG与PPV呈负相关(r=-0.391,P=0.010)。结论HVPG可以辅助判断PA-HSOS患者抗凝有无应答及其疾病预后,多普勒超声参数在一定条件下可以辅助判断PA-HSOS患者的HVPG升高程度。Objective To investigate the relationship between hepatic venous pressure gradient(HVPG)and parameters of Doppler ultrasound in patients with pyrroidine alkaloid-related hepatic sinusoidal obstruction syndrome(PA-HSOS).Methods From February 17,2017 to April 22,2020,the clinical data of 68 patients with PA-HSOS who underwent HVPG manometry and Doppler ultrasound examination at Drum Tower Hospital,the Affiliated Medical College of Nanjing University were retrospectively analyzed,which included HVPG,Drum Tower severity scoring(DTSS),time from PA-HSOS related symptoms appeared to diagnosis after taking pyrroidine alkaloid(hereinafter referred to as diagnosis time),and parameters of Doppler ultrasound induding portal vein trunk diameter(PD),peak portal vein velocity(PPV),splenic vein trunk diameter(SD)and peak splenic vein velocity(PSV).Receiver operating characteristic curve(ROC)was used to determine the optimal cut-off value of HVPG for predicting non-response to anticoagulation therapy.Binary logistic regression was used to analyze the independent risk factors for non-response to anticoagulation therapy,and Kaplan-Meier survival curve was used to analyze the prognostic survival rate of patients with different HVPG levels.Unitary linear regression was applied to analyze the correlation of HVPG with PD,PPV,SD and PSV in patients with different HVPG levels,patients with mild,moderate and severe DTSS,and patients with diagnosis time>1 month or≤1 month.Chi-square test was used for statistical analysis.Results The results of ROC analysis showed that the optimal cut-off value of HVPG for predicting non-response to anticoagulant therapy was 20.165 mmHg(1 mmHg=0.133 kPa).The result of multivariate analysis indicated that high HVPG(HVPG>20.165 mmHg)was an independent risk factor for predicting non-response to anticoagulant therapy(OR(95%confidence interval)=6.039(1.466 to 24.869),P=0.013).Kaplan-Meier survival curve demonstrated that prognostic survival rate of patients with high HVPG was lower than that of patients with l

关 键 词：吡咯生物碱 肝窦阻塞综合征 肝静脉压力梯度 超声 抗凝治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R686[医药卫生—诊断学]