治愈患者的持续性静脉动脉:了解肝动脉压力梯度的作用
Pol Olivas1,2,3,4, Alexandre Soler-Perromat5, Luis Tellez2,6
1Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Fundacióde Recerca Clínic Barcelona - Institut de Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain.
JHEP reports : innovation in hepatology
|October 21, 2024
概括
肝硬化时的病因因子去除可以导致持续的食道静脉,尽管肝静脉压梯度 (HVPG) 较低. 在这些情况下,直接的门口压力测量证实了HVPG的准确性,指导了对持久变节的未来管理策略.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 血管医学 血管医学
背景情况:
- 病因因子去除 (ER) 改善了肝硬化中的门门高血压.
- 尽管肝静脉压梯度 (HVPG) 低于10 mmHg,但ER后的持续性食管静脉 (EV) 和移植系统性分流 (PSS) 引起了关于HVPG准确性的疑问.
研究的目的:
- 评估HVPG和直接门口压力 (DPP) 之间的相关性.
- 为了评估ER后持续EV的患者的HVPG准确性,HVPG<10 mmHg.
主要方法:
- 一个双中心的"概念验证"研究.
- 在HCV或与酒精有关的肝硬化患者中评估HVPG和超声波引导的皮肤通用DPP.
- 包括持久性静脉动脉和HVPG<10 mmHg至少5年ER后的患者.
主要成果:
- 纳入了10名患者 (7名HCV,3名酒精相关肝硬化) 患有持续性静脉动脉和ER后HVPG<10 mmHg.
- 角肝静脉压 (中位数19 mmHg) 和门脉压 (中位数18 mmHg) 显示出良好的相关性 (R=0.93,p<0.0001).
- 门口压力梯度证实了临床上没有显著的门口高血压.
结论:
- 在ER后的肝硬化回归中,HVPG准确地反映了门口压力.
- 尽管HVPG<10 mmHg后ER,食道静脉瘤可能会持续存在.
- 需要进一步的研究来确定在患有持续EV和HVPG<10 mmHg的患者中预防的益处.
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