Comparison between Esophageal Variceal Pressure and Portal Pressure in Hbsag-Positive Cirrhotics: The Effects of Vasopressin

在B型肝炎抗原陽性肝硬化病人食道靜脈曲張壓與門脈壓的比較：血管增壓素之影響

盧啟文(Chi-Wen Lu) ； 趙毅(Yee Chao) ； 王聖賢(Sun-Sang Wang) ； 李發耀(Fa-Yauh Lee) ； 李壽東(Shou-Dong Lee)

《中華民國消化系醫學會雜誌》 12卷2期 (1995/06) Pp. 166-173

https://doi.org/10.6557/GJTa.199506_12(2).0001

摘要

本研究係為了探討食道靜脈曲張壓與門脈壓的關係，以及食道靜脈曲張壓的測量在門脈高壓處理上所擔任的角色。共有十三位B型肝炎抗原陽性肝硬化病人進入本研究，接受血流動力學的測量，其靜脈曲張內壓、食道靜脈曲張壓力差、肝靜脈楔形壓與肝靜脈壓力差分別為21.4±2.8 mmHg、16.2±2.2 mmHg、23.1±5.5 mmHg與14.7±3.9 mmHg。在統計學線性回歸分析下發現，肝靜脈楔形壓與靜脈曲張內壓或肝靜脈壓力差與食道靜脈壓力差之間為非相關。其中九位病人接受靜脈內注射血管增壓素（1國際單位），結果食道靜脈曲張壓力差與肝靜脈壓力差均下降，且前者下降的幅度(4.4±1.4 mmHg、29.0±11.4%)與後者下降的幅度(3.4±0.9 mmHg、24.2±3.8%)有相關的趨勢(r=0.64, p=0.06)。這些結果顯示在B型肝炎抗原陽性肝硬化病人，食道靜脈曲張壓力的測量並不能用來取代門脈壓力。然而食道靜脈曲張壓力的測量，在評估處理門脈高壓的潛在藥效時可能是有價值的。

關鍵字

肝硬化 ； 門脈高壓 ； 食道靜脈曲張

並列摘要

Thirteen patients with HBsAg-positive cirrhosis were studied to investigate the relationship between esophageal variceal pressure and portal pressure, and the role of variceal pressure measurements in the management of portal hypertension. The intravariceal pressure, esophageal variceal pressure gradient, wedged hepatic venous pressure and hepatic venous pressure gradient were 21.4±2.8 mmHg, 16.2±2.2 mmHg, 23.1±5.5 mmHg and 14.7±3.9 mmHg, respectively. Linear regression analysis showed poor correlation between wedged hepatic venous pressure and intravariceal pressure or between hepatic venous pressure gradient and esophageal variceal pressure gradient. In nine patients receiving intravenous infusion of vasopressin (1 IU), both esophageal variceal pressure gradient (15.7±2.0 vs. 11.2±2.6 mmHg, p＜0.01) and hepatic venous pressure gradient (14.7±3.5 vs. 11.0±2.9 mmHg, p＜0.0l) were reduced. The reduction of esophageal variceal pressure gradient after vasopressin infusion (4.4±1.4 mmHg, 29.0±11.4%) tended to correlate with that of hepatic venous pressure gradient (3.4±0.9 mmHg, 24.2±3.8%) (r=0.64, p=0.06). These results indicate that esophageal variceal pressure measurements cannot be used as estimations of portal pressure in HBsAg-positive cirrhotics. However, the measurement of esophageal variceal pressure may be valuable in assessing potential drug effects in the management of portal hypertension.

並列關鍵字

cirrhosis ； portal hypertension ； esophageal varices