目的:评估自身免疫性肝病(ALD)和门静脉高压(PHT)患者肝静脉压力梯度(HVPG)和门静脉压力梯度(PPG)之间的相关性和一致性。并探讨肝静脉络合对评估准确性的影响程度。
方法:选择在2017年至2021年间接受经颈静脉肝内门体分流术(TIPS)常规和创新的15ml加压造影剂的98例ALD患者,以测量楔形肝静脉压(WHVP)和门静脉压(PVP)并计算HVPG和PPG。采用Pearson相关性对两组进行相关性分析。绘制了Bland-Altman地块以估计成对压力之间的一致性。
结果:早期PPG和HVPG的r值,中间,迟到,门静脉显像分别为0.404、0.789、0.807和0.830,R2值分别为0.163、0.622、0.651和0.690。早期组的r和R2值的P值为0.015,其余组的P值均小于0.001。Bland-Altman图显示,门静脉可视化组的患者具有最窄的95%一致性界限(LoA)。差异的平均值接近零刻度线。
结论:在ALD患者中,HVPG和PPG之间的相关性很好,后来的抵押品发展,相关性越好。肝静脉侧支是低估WHVP和HVPG的重要因素,抵押品出现得越早,低估越明显。本文受版权保护。保留所有权利。
OBJECTIVE: To assess the correlation and agreement between hepatic venous pressure gradient (HVPG) and portal pressure gradient (PPG) in patients with autoimmune liver diseases (ALD) and portal hypertension, and to investigate the extent to which hepatic vein collateralization affects the accuracy of this assessment.
METHODS: Ninety-eight patients with ALD between 2017 and 2021 who underwent transjugular intrahepatic portosystemic shunt with conventional and innovative 15 mL pressurized contrast were selected to measure wedged hepatic venous pressure (WHVP) and portal venous pressure and to calculate the HVPG and PPG. Pearson\'s correlation was used for correlation analysis between the two groups. Bland-Altman plots were plotted to estimate the agreement between paired pressures.
RESULTS: The r values of PPG and HVPG in the early, middle, late, and portal venous visualization were 0.404, 0.789, 0.807, and 0.830, respectively, and the R2 values were 0.163, 0.622, 0.651, and 0.690, respectively. The p value for the r and R2 values in the early group was 0.015, and the p values in the remaining groups were less than 0.001. Bland-Altman plots showed that patients in the portal venous visualization group had the narrowest 95% limits of agreement. The mean value of the difference was close to the zero-scale line.
CONCLUSIONS: In patients with ALD, the correlation between the HVPG and PPG was good, and the later the collateral development, the better the correlation. Hepatic vein collateral was an essential factor in underestimating WHVP and HVPG, and the earlier the collateral appeared, the more obvious the underestimation.