Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism
Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism
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DOI：
10.1007/s00535-021-01762-7
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发表时间：
2021-02-24
影响因子：
6.3
通讯作者：
Sakaida, Isao
中科院分区：
文献类型：
--
作者：
Ishikawa, Tsuyoshi;Sasaki, Ryo;Sakaida, Isao
背景本研究旨在研究部分脾栓塞术（PSE）引起的肝静脉压力梯度（HVPG）的变化，并确定术后HVPG降低具有临床意义的决定因素。方法选择2007年9月至2020年6月在我科行PSE的肝硬化脾功能亢进患者68例。在PSE前和PSE后即刻评价HVPG。根据术前HVPG分为低HVPG组（< 10 mmHg，n = 22）、中HVPG组（10 mmHg = 16 mmHg，n = 13）。结果总体而言，PSE使HVPG从12.2 ± 4.0 mmHg显著降低至9.4 ± 3.6 mmHg（p < 0.01），相对降低22.2 ± 20.4%。此外，低、中和高HVPG组的HVPG降低分别为19.4 +/-28.7%、24.0 +/-15.9%和22.5 +/- 13.3%，表明组间HVPG降低无显著差异。在所有患者中，55.9%的患者HVPG较基线降低>= 20%，在本研究中定义为对PSE的临床显著HVPG应答。多变量logistic回归和受试者工作特征曲线分析表明，脾非梗死体积是HVPG降低20%的独立决定因素（p < 0.05），临界值为139.2 cm（3）（敏感性76.3%，特异性60.0%，p < 0.05）。结论脾非梗死体积，即剩余功能脾体积，独立决定了肝硬化脾功能亢进患者对PSE的临床显著HVPG反应。
Background This study aimed to investigate changes in the hepatic venous pressure gradient (HVPG) by partial splenic embolization (PSE) and to identify the determinants of a clinically meaningful postoperative HVPG reduction. Methods Sixty-eight patients with cirrhosis and hypersplenism who underwent PSE at our department between September 2007 and June 2020 were included. The HVPG was evaluated pre- and immediately post-PSE. The patients were divided into three groups according to their preprocedural HVPG: low-HVPG (< 10 mmHg, n = 22), intermediate-HVPG (10 mmHg = 16 mmHg, n = 13). Results Overall, PSE significantly reduced HVPG from 12.2 +/- 4.0 to 9.4 +/- 3.6 mmHg (p < 0.01) with a relative decrease of 22.2 +/- 20.4%. In addition, HVPG reductions were 19.4 +/- 28.7%, 24.0 +/- 15.9%, and 22.5 +/- 13.3% in the low-, intermediate-, and high-HVPG groups, respectively, indicating no significant difference in HVPG reduction between the groups. An HVPG decrease of >= 20% from the baseline, defined in this study as a clinically significant HVPG response to PSE, was achieved in 55.9% of all patients. Multivariate logistic regression and receiver operating characteristic curve analyses identified splenic non-infarction volume as an independent determinant of a 20% decrease in HVPG (p < 0.05), with a cut-off of 139.2 cm(3) (sensitivity, 76.3%; specificity, 60.0%; p < 0.05). Conclusions The splenic non-infarction volume, namely the residual functional spleen volume, independently determines a clinically significant HVPG response to PSE in patients with cirrhosis and hypersplenism.