Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension  

作　　者：Dan Zhang Tao Wang Zhen-Dong Yue Lei Wang Zhen-Hua Fan Yi-Fan Wu Fu-Quan Liu 

机构地区：[1]Department of Interventional Therapy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China [2]Department of Interventional Therapy,Yantai Yuhuangding Hospital of Qingdao University,Yantai 264099,Shandong Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2023年第11期2490-2499,共10页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and ascites.The hepatic venous pressure gradient(HVPG),which is easier to measure,has replaced the portal venous pressure gradient(PPG)as the gold standard for diagnosing PHT in clinical practice.Therefore,attention should be paid to the correlation between HVPG and PPG.METHODS Between January 2017 and June 2020,134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures.Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient(r)and determination coefficient(R^(2)).Bland-Altman plots were constructed to further analyze the agreement between the measurements.Disagreements were analyzed using paired t tests,and P values<0.05 were considered statistically significant.RESULTS In this study,the correlation coefficient(r)and determination coefficient(R2)between HVPG and PPG were 0.201 and 0.040,respectively(P=0.020).In the 108 patients with no collateral branch,the average wedged hepatic venous pressure was lower than the average portal venous pressure(30.65±8.17 vs.33.25±6.60 mmHg,P=0.002).Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography(19.4%),while the average PPG was significantly higher than the average HVPG(25.94±7.42 mmHg vs 9.86±7.44 mmHg;P<0.001).The differences between HVPG and PPG<5 mmHg in the collateral vs no collateral branch groups were three cases(11.54%)and 44 cases(40.74%),respectively.CONCLUSION In most patients,HVPG cannot accurately represent PPG.The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.

关 键 词：Portal hypertension Portal venous pressure gradient Hepatic venous pressure gradient Alcoholic cirrhosis Hepatic collateral 

分 类 号：R575.2[医药卫生—消化系统]