肝硬化临床特征与超声内镜引导下门静脉压力梯度的相关性研究

Correlation between clinical features of liver cirrhosis and endoscopic ultrasound‑guided portal pressure gradient

摘要:

目的 探讨肝硬化患者临床特征与超声内镜引导下门静脉压力梯度（endoscopic ultrasound‑guided portal pressure gradient，EUS‑PPG）的相关性。方法 选取2022年3月15日至2023年6月20日于中南大学湘雅三医院行EUS‑PPG测定的148例肝硬化门静脉高压症患者，收集患者测压前的临床资料并分析不同临床特征亚组EUS‑PPG的差异，采用多因素线性回归分析探索EUS‑PPG的独立影响因素。结果 具有红色征［（16.62±5.33）mmHg（1 mmHg=0.133 kPa）比（13.44±5.34）mmHg，t=3.616，P<0.001］、胃食管静脉曲张［（15.78±5.30）mmHg比（9.70±4.77）mmHg，t=4.247，P<0.001］、肝性脑病［（20.83±7.52）mmHg比（14.92±5.35）mmHg，t=2.606，P=0.010］、血小板减少［（15.66±5.39）mmHg比（13.29±5.83）mmHg，t=2.136，P=0.034］、低白蛋白血症［（16.13±5.86）mmHg比（14.12±5.03）mmHg，t=2.230，P=0.027］、国际标准化比值升高［（16.25±6.00）mmHg比（14.40±5.11）mmHg，t=2.022，P=0.045］临床特征的患者EUS‑PPG显著增加。既往有脾切除+断流术史的患者EUS‑PPG显著降低［（13.17±5.88）mmHg比（15.73±5.34）mmHg，t=-2.379，P=0.019］；患者EUS‑PPG随腹水程度加重逐渐增加［无腹水比少量腹水比中-大量腹水：（13.40±5.48）mmHg比（15.90±5.49）mmHg比（16.69±5.17）mmHg，F=5.188，P=0.007］；患者EUS‑PPG随Child‑Pugh分级升高逐渐增加［A级比B级比C级：（14.07±5.05）mmHg比（15.69±5.74）mmHg比（17.64±5.99）mmHg，F=3.066，P=0.049］。多因素线性回归分析提示红色征（β=2.44，t=2.732，P=0.007）、胃食管静脉曲张（β=4.45，t=2.990，P=0.003）、腹水（β=1.75，t=2.368，P=0.019）和肝性脑病（β=5.82，t=2.644，P=0.009）是EUS‑PPG升高的独立影响因素。结论 EUS‑PPG与肝硬化门静脉高压症严重程度相关的临床特征之间存在显著的一致性，EUS‑PPG评估肝硬化门静脉高压症具有可行性。

Abstract:

Objective To investigate the correlation between the clinical features and endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) in patients with cirrhosis. Methods A total of 148 patients with cirrhosis and portal hypertension who underwent EUS-PPG measurement at the Third Xiangya Hospital of Central South University from March 15, 2022 to June 20, 2023 were selected. The clinical data of patients collected before EUS-PPG measurement were analyzed. Variations in the EUS-PPG across different clinical data subgroups were analyzed. Multivariate linear regression analysis was used to explore the independent factors influencing EUS-PPG. Results The EUS-PPG was significantly elevated in patients exhibiting red signs (16.62±5.33 mmHg VS 13.44±5.34 mmHg, t=3.616, P<0.001), gastroesophageal varices (15.78±5.30 mmHg VS 9.70±4.77 mmHg, t=4.247, P<0.001), hepatic encephalopathy (20.83±7.52 mmHg VS 14.92±5.35 mmHg, t=2.606, P=0.010), thrombocytopenia (15.66±5.39 mmHg VS 13.29±5.83 mmHg, t=2.136, P=0.034), hypoproteinemia (16.13±5.86 mmHg VS 14.12±5.03 mmHg, t=2.230, P=0.027), and an increased international normalized ratio (16.25±6.00 mmHg VS 14.40±5.11 mmHg, t=2.022, P=0.045). Conversely, the EUS-PPG was significantly reduced in patients with a history of splenectomy and devascularization (13.17±5.88 mmHg VS 15.73±5.34 mmHg, t=-2.379, P=0.019). The EUS-PPG in patients with varying degrees of ascites (no VS slight VS moderate or severe: 13.40±5.48 mmHg VS 15.90±5.49 mmHg VS 16.69±5.17 mmHg, F=5.188, P=0.007) and different Child-Pugh classifications (A VS B VS C: 14.07±5.05 mmHg VS 15.69±5.74 mmHg VS 17.64±5.99 mmHg, F=3.066, P=0.049) increased gradually. Multivariable linear regression analysis showed that red signs (β=2.44, t=2.732, P=0.007), gastroesophageal varices (β=4.45, t=2.990, P=0.003), ascites (β=1.75, t=2.368, P=0.019), and hepatic encephalopathy (β=5.82, t=2.644, P=0.009) were independent factors for the elevated EUS-PPG. Conclusion There is a significant correlation between EUS-PPG and the clinical features related to the severity of cirrhotic portal hypertension, which indicates the feasibility of EUS-PPG in evaluating cirrhotic portal hypertension.