肝静脉压力梯度微创时代:基于前臂静脉入路的探索  

HVPG minimally invasive era: exploration based on forearm venous approach

作　　者：王继涛 李雷[2] 牛猛[3] 朱清亮 赵中伟[5] Kohei Kotani Akira Yamamoto 张海军[2] 李双喜[2] 徐丹 康宁 李小果 张昆鹏 孙骏[3] 吴发宗[5] 张海龙 刘登湘 吕沐瀚 纪建松[5] Norifumi Kawada 徐克[3] 祁小龙 Wang Jitao;Li Lei;Niu Meng;Zhu Qingliang;Zhao Zhongwei;Kohei Kotani;Akira Yamamoto;Zhang Haijun;Li Shuangxi;Xu Dan;Kang Ning;Li Xiaoguo;Zhang Kunpeng;Sun Jun;Wu Fazong;Zhang Hailong;Liu Dengxiang;Lyu Muhan;Ji Jiansong;Norifumi Kawada;Xu Ke;Qi Xiaolong(Hebei Province Key Laboratory of Hepatocirrhosis and Portal Hypertension,Xingtai People's Hospital Affiliated to Hebei Medical University,Xingtai 054000,China;Interventional Department,Lanzhou University First Hospital,Lanzhou 730000,China;Interventional Department,the First Afiliated Hospital of China Medical University,Shenyang I0000,China;'Department of Gastroenterology,Affliated Hospital of Southwest Medical University,Lanzhou 646000,China;Interventional Diagnosis and Treatment Center Lishui Central Hospital,Lishui 323000,China;Department of Hepatology,Osaka Municipal University Hospital,Osaka City,Japan;Department of Interventional Radiology,Faculty of Medicine,Osaka City University,Osaka City,Japan;Portal Hypertension Centers,Southeast University Affiliated Zhongda Hospital,Nanjing 210009,China)

机构地区：[1]河北省肝硬化门静脉高压重点实验室河北医科大学附属邢台市人民医院邢台054000 [2]兰州大学第一医院介入科,兰州730000 [3]中国医科大学附属第一医院介入科,沈阳110000 [4]西南医科大学附属医院消化内科,泸州646000 [5]丽水市中心医院介入诊疗中心,丽水323000 [6]日本大阪市立大学医院肝病科,日本大阪 [7]日本大阪市立大学医学院放射介入科,日本大阪 [8]东南大学附属中大医院门静脉高压中心,南京210009

出　　处：《中华肝脏病杂志》2024年第1期35-39,共5页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81600510);河北省重点研发计划项目(22377745D);河北省自然基金项目(H2022108003);广州市产学研协同创新重大专项(201704020015)。

摘　　要：目的经颈静脉或经股动脉途径被用作当前实践中肝静脉压力梯度(HVPG)测量的常用方法。该研究旨在证实经前臂静脉途径测量HVPG的安全性和有效性。方法针对2020年9月至2020年12月前瞻性地从中国和日本的6所医院招募了经前臂静脉进行HVPG检测肝硬化患者,并收集患者的临床基线资料以及HVPG检测数据。入组患者均选择经右侧肘正中静脉或贵要静脉入路,采用HVPG标准化流程进行测压。研究数据采用SPSS 22.0统计学软件进行分析。定量资料采用中位数(四分位数间距)表示,定性资料采用频数和率表示。两组数据之间的相关性分析采用Pearson相关性分析。结果研究共入组43例患者,其中41例(95.3%)患者成功接受了经前臂静脉途径HVPG检测。无患者出现任何严重并发症。经前臂静脉途径HVPG检测中位操作时间为18.0min(12.3~38.8min)。研究证实HVPG与Child-Pugh评分(r=0.47,P=0.002)、白蛋白-胆红素评分(r=0.37,P=0.001)、Lok指数(r=0.36,P=0.02)、肝脏硬度(r=0.58,P=0.01)、脾硬度(r=0.77,P=0.01)呈正相关,且与白蛋白呈负相关(r=-0.42,P=0.006)。结论多中心回顾性研究结果提示经前臂静脉途径HVPG测量是安全可行的。Objective The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient(HVPG)measurement in current practice.This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020.Patients'clinical baseline information and HVPG measurement data were collected.The right median cubital vein or basilic vein approach for all enrolled patients was selected.The HVPG standard process was used to measure pressure.Research data were analyzed using SPSS 22.0 statistical software.Quantitative data were used to represent medians(interquartile ranges),while qualitative data were used to represent frequency and rates.The correlation between two sets of data was analyzed using Pearson correlation analysis.Results A total of 43 cases were enrolled in this study.Of these,41(95.3%)successfully underwent HVPG measurement via the forearm venous approach.None of the patients had any serious complications.The median operation time for HVPG detection via forearm vein was 18.0 minutes(12.3~38.8 minutes).This study confirmed that HVPG was positively closely related to Child-Pugh score(r=0.47,P=0.002),albumin-bilirubin score(r=0.37,P=0.001),Lok index(r=0.36,P=0.02),liver stiffness(r=0.58,P=0.01),and spleen stiffness(r=0.77,P=0.01),while negatively correlated with albumin(r=-0.42,P=0.006).Conclusion The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

关 键 词：肝硬化 肝静脉压力梯度 前臂静脉 

分 类 号：R575[医药卫生—消化系统]