肝静脉压力梯度对失代偿性肝硬化患者预后的预测作用

肝脏 ›› 2023, Vol. 28 ›› Issue (6): 649-653.

肝静脉压力梯度对失代偿性肝硬化患者预后的预测作用

魏峰, 王剑, 施健, 魏珏

200003 上海海军军医大学附属长征医院消化内科(魏峰,王剑,施健);上海交通大学医学院附属同仁医院消化内科(魏珏)

收稿日期:2023-01-03 出版日期:2023-06-30 发布日期:2023-08-30
通讯作者: 魏珏,Email:weijuemd@shsmu.edu.cn
基金资助:
上海市卫生和计划生育委员会科研项目(201840233);上海市科委自然科学基金项目(21ZR1458700,19ZR1457100)

Predictive value of hepatic venous pressure gradient on the prognosis of patients with decompensated liver cirrhosis

WEI Feng¹, WANG Jian¹, SHI Jian¹, WEI Jue²

1. Department of Gastroenterology, Changzheng Hospital, Naval Medical University,Shanghai 200003,China;
2. Department of Gastroenterology, Tong Ren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, China

Received:2023-01-03 Online:2023-06-30 Published:2023-08-30
Contact: WEI Jue, Email:weijuemd@shsmu.edu.cn

摘要/Abstract

摘要： 目的探讨肝静脉压力梯度在失代偿性肝硬化患者预后评价中的作用。方法筛选2016年9月至2020年12月于上海长征医院住院治疗的失代偿肝硬化患者,依据纳入标准和排除标准共纳入51例。使用血管介入方法测定肝静脉压力梯度(HVPG)。使用受试者工作特征曲线下面积(AUROC)的方法分析HVPG预测预后的准确性。使用X-tile软件分析得出连续性变量的最佳截止值,Kaplan-Meier方法分析总体生存率。构建在Cox 回归模型中评估独立预测因素的风险比。结果失代偿性肝硬化患者HVPG 测量平均值为(20.68±9.02)mmHg。HVPG预测总体死亡率的AUROC为0.729;HVPG ≤ 19 mmHg的失代偿性肝硬化患者死亡率显著低于HVPG >19 mmHg的患者 (P=0.005)。在单因素COX变量分析中,胆红素、ALT、CTP评分、HVPG (HR:1.051;95% CI:1.093~1.112;P=0.026) 和MELD评分与长期死亡率显著相关。在使用多因素Cox回归模型分析中,只有 HVPG (HR:1.079;95% CI:1.009~1.15; P=0.027)和胆红素显著相关。结论 HVPG对失代偿性肝硬化患者的预后具有较好的预测价值。

关键词: 失代偿性肝硬化, 肝静脉压力梯度, 预后, 生存时间

Abstract: Objective To investigate the role of hepatic venous pressure gradient (HVPG) in the prognosis of patients with decompensated cirrhosis. Methods A total of 51 patients with decompensated cirrhosis admitted to our hospital from September 2016 to December 2020 were selected. The HVPG was measured by vascular intervention. The area under receiver operating characteristic curve (AUROC) method was used to analyze the accuracy of HVPG in predicting prognosis. X-tile software was used to derive optimal cutoff values for continuity variables. The overall survival rate was analyzed by Kaplan-Meier method. A Cox regression model was established to evaluate the risk ratio of independent predictors. Results The value of HVPG in patients with decompensated cirrhosis was 20.68 ± 9.02 mmHg. The AUROC of total mortality predicted by HVPG was 0.729. The overall mortality of patients with decompensated cirrhosis was significantly different. Patients with decompensated cirrhosis with HVPG ≤ 19 mmHg had a significantly lower mortality rate than those with HVPG>19 mmHg (P=0.005). In univariate COX variable analysis, bilirubin, alanine aminotransferase (ALT), Child-Turcotte-Pugh (CTP) score, HVPG (HR: 1.051; 95%CI: 1.093-1112; P=0.026), and model for end-stage liver disease (MELD) score were significantly correlated with long-term mortality in patients with decompensated cirrhosis. In multivariate Cox regression analysis, only HVPG (HR: 1.079; 95% CI: 1.009-1.15; P=0.027) and bilirubin were significantly correlated with long-term mortality. Conclusion HVPG has a good predictive value for the prognosis of patients with decompensated liver cirrhosis.

Key words: Decompensated cirrhosis, Hepatic vein pressure gradient, Prognosis, Survival time

魏峰, 王剑, 施健, 魏珏. 肝静脉压力梯度对失代偿性肝硬化患者预后的预测作用[J]. 肝脏, 2023, 28(6): 649-653.

WEI Feng, WANG Jian, SHI Jian, WEI Jue. Predictive value of hepatic venous pressure gradient on the prognosis of patients with decompensated liver cirrhosis[J]. Chinese Hepatolgy, 2023, 28(6): 649-653.

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