Portal Venous Remodeling Determines the Pattern of Cirrhosis Decompensation: A Systems Analysis.
Portal Venous Remodeling Determines the Pattern of Cirrhosis Decompensation: A Systems Analysis.
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DOI：
10.14309/ctg.0000000000000590
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发表时间：
2023-09-01
影响因子：
3.6
通讯作者：
Beard, Daniel A.
中科院分区：
文献类型：
--
作者：
Mazumder, Nikhilesh R.;Jezek, Filip;Tapper, Elliot B.;Beard, Daniel A.
随着肝病的进展，瘢痕形成导致血流动力学恶化，最终导致门静脉高压。该过程已经经典地通过门体压力梯度（PSG）来量化，门体压力梯度（PSG）在临床上通过肝静脉压力梯度（HVPG）来估计;然而，单独的PSG不能预测给定患者关于肝硬化的Baveno阶段的临床轨迹。我们假设患者的PSG对静脉重塑的敏感性可以解释不同的疾病轨迹。我们创建了一个门静脉系统的计算模型，在恶化的肝脏疾病的背景下，从门静脉高压症领域的生理测量。我们模拟了临床并发症、HVPG和经颈静脉肝内门体分流术的进展，同时仅改变患者门静脉重塑的可能性。我们的研究结果将血流动力学、静脉重塑和肝病的临床进展统一为一个数学上一致的门静脉高压模型。我们发现，通过改变患者对PSG升高产生静脉侧支的敏感程度，我们可以解释肝病患者失代偿模式的变化。具体来说，我们发现，在疾病早期有较高比例的门体分流的患者，HVPG的升高减弱，腹水发生延迟，经颈静脉肝内门体分流术后血流动力学变化较小。本文建立了一个门脉高压的计算模型，支持静脉重塑的患者水平差异可以解释疾病的不同临床轨迹。
As liver disease progresses, scarring results in worsening hemodynamics ultimately culminating in portal hypertension. This process has classically been quantified through the portosystemic pressure gradient (PSG), which is clinically estimated by hepatic venous pressure gradient (HVPG); however, PSG alone does not predict a given patient's clinical trajectory regarding the Baveno stage of cirrhosis. We hypothesize that a patient's PSG sensitivity to venous remodeling could explain disparate disease trajectories. We created a computational model of the portal system in the context of worsening liver disease informed by physiologic measurements from the field of portal hypertension. We simulated progression of clinical complications, HVPG, and transjugular intrahepatic portosystemic shunt placement while only varying a patient's likelihood of portal venous remodeling. Our results unify hemodynamics, venous remodeling, and the clinical progression of liver disease into a mathematically consistent model of portal hypertension. We find that by varying how sensitive patients are to create venous collaterals with rising PSG we can explain variation in patterns of decompensation for patients with liver disease. Specifically, we find that patients who have higher proportions of portosystemic shunting earlier in disease have an attenuated rise in HVPG, delayed onset of ascites, and less hemodynamic shifting after transjugular intrahepatic portosystemic shunt placement. This article builds a computational model of portal hypertension which supports that patient-level differences in venous remodeling may explain disparate clinical trajectories of disease.
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影响因子：
29.4
作者：
IWAO, T;TOYONAGA, A;TANIKAWA, K
通讯作者：
TANIKAWA, K
DOI：
10.5005/jp-journals-10018-1235
发表时间：
2017-07-01
期刊：
Euroasian journal of hepato-gastroenterology
影响因子：
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影响因子：
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DOI：
10.1016/j.jvir.2020.08.027
发表时间：
2020-12-01
影响因子：
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作者：
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