超声内镜测定门静脉压力梯度的临床意义

肝脏 ›› 2025, Vol. 30 ›› Issue (3): 301-304.

超声内镜测定门静脉压力梯度的临床意义

马颖慧, 林赫, 王磊, 张裕, 赵亚莉

100069 北京首都医科大学附属北京佑安医院肿瘤内科(马颖慧,赵亚莉);北京大学第一医院特需门诊(林赫);首都医科大学附属北京世纪坛医院介入治疗科(王磊,张裕)

收稿日期:2024-01-20 出版日期:2025-03-31 发布日期:2025-06-16
通讯作者: 林赫,Email: xsc125463@126.com
基金资助:
首都卫生发展科研专项项目书(2018-1-2081)

The application and influencing factors of endoscopic ultrasound in measuring portal vein pressure gradient in patients with liver cirrhosis and portal hypertension

MA Ying-hui¹, LIN He², WANG Lei³, ZHANG Yu³, ZHAO Ya-li¹

1. Department of Oncology,Beijing You'an Hospital Affiliated to Capital Medical University, Beijing l00069, China;
2. VIP Clinic, Peking University First Hospital, Beijing 100069, China;
3. Department of Interventional Therapy,Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038, China

Received:2024-01-20 Online:2025-03-31 Published:2025-06-16
Contact: LIN He,Email:xsc125463@126.com

摘要/Abstract

摘要： 目的探究超声内镜在肝硬化门静脉高压患者门静脉压力梯度(PPG)测定中的应用价值。方法选取2022年1月至2023年10月在北京佑安医院收治的疑似肝硬化门静脉高压患者122例。通过超声内镜测定PPG,经右颈静脉穿刺测定肝静脉压力梯度(HVPG)。对比有无肝硬化门静脉高压、不同程度以及不同肝功能等级的肝硬化门静脉高压患者的PPG以及HVPG。通过受试者工作曲线下面积(AUC)分析PPG值对肝硬化门静脉高压及其严重程度的诊断价值。结果超声内镜引导测定PPG值的手术成功率为98.4%(120/122)。采用超声内镜测得PPG值(18.74±10.1)mmHg,经颈静脉穿刺测得HVPG值(19.06±8.2)mmHg,差异无统计学意义(t=0.269,P=0.788)。无门静脉高压组患者的PPG为(10.7±3.3)mmHg,有门静脉高压组为(20.7±10.5)mmHg;轻度门静脉高压组的PPG为(16.2±4.1)mmHg,重度门静脉高压组为(25.2±7.6)mmHg,差异均有统计学意义(t=5.646、7.230,P<0.001)。Child肝功能A级、B级以及C级患者PPG值分别为(16.2±8.3)mmHg、(18.9±7.3)mmHg、(17.3±8.8)mmHg,差异无统计学意义(F=1.657,P=0.195)。 PPG诊断门静脉高压的AUC为0.981,诊断门静脉高压严重程度的AUC为0.947,均有较好的诊断价值。结论对于肝硬化门静脉高压患者的诊断采用超声内镜引导下PPG的测定可以替代HVPG的测定。

关键词: 超声内镜, 肝硬化, 门静脉压力梯度, 门静脉高压, 应用

Abstract: Objective To explore the application and influencing factors of endoscopic ultrasound in the measurement of portal pressure gradient of patients with liver cirrhosis and portal hypertension.Methods A total of 122 patients with suspected cirrhosis and portal hypertension admitted to Beijing You'an hospital from January 2022 to October 2023 were selected as the study subjects. The general information of the study subjects, measured values of portal vein pressure gradient (PPG), hepatic vein pressure gradient (HVPG), and surgical related indicators were recorded. The measurement values of PPG and HVPG in patients with and without cirrhosis portal hypertension, and the measurement values of PPG and HVPG in cirrhotic patients with different portal hypertension degrees and liver function levels wer compared, and the diagnostic value of PPG values for cirrhosis portal hypertension and its severity were analyzed through the area under the curve (AUC) of receiver operating curve (ROC).Results The surgical success rate of PPG value guided by endoscopic ultrasound in this study was 98.4%. The PPG value measured by EUS method was (18.74±10.1) mmHg, while the HVPG value measured by jugular vein puncture was (19.06±8.2) mmHg (t=0.269, P=0.788), There was no significant difference between the values of the two groups. The PPG value of (10.7±3.3) mmHg in the group without portal hypertension was significantly lower than that of (20.7±10.5) mmHg in the group with portal hypertension (t=5.646, P=0.000). The PPG value of (16.2±4.1)mmHg in the mild portal hypertension group was significantly lower than that of (25.2±7.6) mmHg in the severe portal hypertension group, (t=7.230, P=0.000). The PPG values of children with liver function grades A, B, and C were (16.2±8.3) mmHg, (18.9±7.3) mmHg, and (17.3±8.8) mmHg (t=1.657, P=0.195), respectively. ROC curve analysis shows that PPG measurement values have good diagnostic values for diagnosing portal hypertension (0.981, P=0.000) and the severity of portal hypertension (0.947, P=0.000).Conclusion For the diagnosis of patients with liver cirrhosis and portal hypertension, ultrasound guided PPG measurement can be used, instead of HVPG measurement, which provide a new mean for the diagnosis and evaluation portal hypertension in patients with liver cirrhosis.

Key words: Endoscopic ultrasound, Liver cirrhosis, Portal vein pressure gradient, Portal hypertension, Application

马颖慧, 林赫, 王磊, 张裕, 赵亚莉. 超声内镜测定门静脉压力梯度的临床意义[J]. 肝脏, 2025, 30(3): 301-304.

MA Ying-hui, LIN He, WANG Lei, ZHANG Yu, ZHAO Ya-li. The application and influencing factors of endoscopic ultrasound in measuring portal vein pressure gradient in patients with liver cirrhosis and portal hypertension[J]. Chinese Hepatolgy, 2025, 30(3): 301-304.

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