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超声内镜引导下无创测量门静脉压力法测定肝硬化门静脉高压的动物实验
An animal experimental study on endoscopic ultrasound-guided non-invasive measurement of portal venous pressure in liver cirrhosis
- 局解手术学杂志 2025年34卷第1期 页码：11-15
- 作者机构：
1.深圳市宝安区石岩人民医院消化内科，广东 深圳518108
2.深圳市宝安区石岩人民医院超声科，广东 深圳518108
- 作者简介：
沈文英，E-mail：275163896@qq.com
- 基金信息：深圳市宝安区科技计划基础研究项目(20210315151936002)
DOI：10.11659/jjssx.03E024016
中图分类号： R575.2纸质出版日期：2025-01-25，
收稿日期：2024-03-04，
- 稿件说明：
移动端阅览
屈卫翔, 沈文英, 杨光朝, 等. 超声内镜引导下无创测量门静脉压力法测定肝硬化门静脉高压的动物实验[J]. 局解手术学杂志, 2025,34(1):11-15.
QU WEI-XIANG, SHEN WEN-YING, YANG GUANG-CHAO, et al. An animal experimental study on endoscopic ultrasound-guided non-invasive measurement of portal venous pressure in liver cirrhosis. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 11-15.
屈卫翔, 沈文英, 杨光朝, 等. 超声内镜引导下无创测量门静脉压力法测定肝硬化门静脉高压的动物实验[J]. 局解手术学杂志, 2025,34(1):11-15. DOI： 10.11659/jjssx.03E024016.
QU WEI-XIANG, SHEN WEN-YING, YANG GUANG-CHAO, et al. An animal experimental study on endoscopic ultrasound-guided non-invasive measurement of portal venous pressure in liver cirrhosis. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 11-15. DOI： 10.11659/jjssx.03E024016.
摘要
目的
2
比较超声内镜（EUS）引导下无创测量门静脉压力法与EUS引导下门静脉压力梯度测量法（EUS-PPG）检测动物门静脉压力的差异及其相关性。
方法
2
选取24只小型猪，采用四氯化碳与苯巴比妥钠配合高脂低蛋白低胆碱饮食喂养16周，制备肝硬化门静脉高压模型，观察实验猪肝功能生化指标及肝病理学改变，评价是否建模成功。建模成功后，采用EUS引导下无创测量门静脉主干血流动力学参数，包括门静脉血流量和脾动脉搏动指数，计算门静脉压力。然后采用EUS-PPG，在全身麻醉下经线阵内镜超声引导，使用18G穿刺针穿刺门静脉、肝静脉、下腔静脉，通过中心静脉压监测系统，计算PPG。采用
Pearson
相关性分析、
Kappa
检验、
ICC
组内相关系数及
Bland
-
Altman
图进行一致性分析。
结果
2
24只实验猪建模后观察16周均存活，建模后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、白蛋白（ALB）、球蛋白（GLB）、总胆红素（TBIL）及间接胆红素（IBIL）水平较建模前升高（
P
<
0.05），HE染色及天狼星红染色显示建模后肝形态异常、胶原纤维增多，提示肝硬化门静脉高压实验猪模型建立成功。EUS引导下无创测量门静脉压力法结果显示，平均脾动脉搏动指数为（2.03±0.68），平均门静脉血流量为（17.27±4.31）cm/s，平均门静脉压力为（15.97±3.65）mmHg。EUS-PPG的测定结果：平均门静脉压力为（20.68±4.71）mmHg，平均肝静脉压力为（
4.07±2.14）mmHg，平均PPG为（16.38±4.28）mmHg。
Pearson
相关性分析发现，两种方法测得的门静脉压力呈显著正相关（
r
=0.902，
P
<
0.001）；
Kappa
检验、
ICC
组内相关系数进行一致性检验，发现两种方法的测量结果具有较高一致性（
Kappa
=0.699，
P
<
0.001；
ICC
=0.945）；
Bland
-
Altman
图分析显示，大部分点都落在95%一致性界限之内。
结论
2
EUS引导下无创测量门静脉压力法结果与EUS-PPG测量结果具有较高的相关性和一致性，成功率高，反映门静脉压准确，且成本低、安全性好。
Abstract
Objective
2
To compare the differences of endoscopic ultrasound （EUS）-guided non-invasive measurement of portal venous pressure and EUS-guided portal pressure gradient（EUS-PPG） in measurement of portal venous pressure on animals and their correlation.
Methods
2
Twenty-four miniature pigs were selected and fed with carbon tetrachloride and phenobarbital sodium combined with high-fat，low-protein and low-choline diet for 16 weeks to establish a liver cirrhotic portal hypertension model.The changes of biochemical indexes of liver function and liver pathology in the experimental pigs were observed to evaluate whether the model was successful.After the model was successfully established，the hemodynamic parameters of the portal venous trunk were measured non-invasively under EUS guidance，including portal venous blood flow and splenic artery pulsatility index，thereby calculating portal venous pressure.Then， taking EUS-PPG， the portal vein， hepatic vein， and inferior vena cava were punctured with an 18G puncture needle under general anesthesia guided by the translinear endoscopic ultrasound， and the PPG was calculated through the central venous pressure monitoring system.The
Pearso
n correlation analysis，
Kappa
test，
ICC
intraclass correlation coefficient and
Bland
-
Altman
plot were used for consistency analysis.
Results
2
All the 24 pigs survived 16 weeks after modeling.The serum levels of alanine transaminase （ALT），aspartate transaminase （AST），albumin （ALB），globulin （GLB），total bilirubin （TBIL） and indirect bilirubin （IBIL）after modeling were higher than those before modeling（
P
<
0.05）.HE staining and Sirius red staining showed abnormal liver morphology and increased collagen fibers after modeling，suggesting that the experimental pig model of liver cirrhotic portal hypertension was successfully established. The results of EUS-guided non-invasive measurement of portal venous pressure showed that the mean splenic artery pulsatility index was （2.03±0.68），the mean portal vein flow was （17.27±4.31）cm/s，and the mean portal venous pressure was （15.97±3.65）mmHg.The measurement results of the mean portal venous pressure，hepatic venous pressure and PPG of EUS-PPG were （20.68±4.71）mmHg，（4.07±2.14）mmHg and （16.38±4.28）mmHg respectively.
Pearson
correlation analysis showed that there was a significant positive correlation between the portal venous pressures measured by the two methods （
r
=0.902，
P
<
0.001）；the consistency tests of
Kappa
test and
ICC
intraclass correlation coefficient showed that the measurement results of the two methods were highly consistent （
Kappa
=0.699，
P
<
0.001；
ICC
=0.945）；
Bland
-
Altman
plot analysis showed that most of the points fell within 95% limits of agreement.
Conclusion
2
EUS-guided non-invasive measurement of portal venous pressure has a high correlation and consistency with the measurement results by EUS-PPG， which has high success rate ，and accurate reflection of portal venous pressure，with low cost and good safety.
关键词
门静脉高压肝硬化内镜超声肝静脉压力梯度门静脉
Keywords
portal hypertensionliver cirrhosis，endoscopic ultrasoundhepatic venous pressure gradientportal vein
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