基于虚拟肝静脉压力梯度新技术的肝硬化门脉高压无创诊断研究

Portal hypertension, as an important characteristic of decompensated cirrhosis, is always diagnosed due to its serious complications in the late stage. Therefore, it is urgent to develop a noninvasive and accurate diagnostic technique for early-stage portal hypertension in the world. In the previous study, our group developed a potential noninvasive diagnostic approach to evaluate portal pressure based on three-dimensional reconstruction and fluid dynamics analysis. In this project, we propose firstly the concept of virtual hepatic venous pressure gradient (vHVPG). Then, three-dimensional hepatic vein-portal vein system model will be reconstructed with imaging control software, and standard procedure of fluid dynamics simulation will be fixed with the platform of finite element calculation. As a result, a novel technique of vHVPG will be initially established. The diagnostic value of vHVPG will be further demonstrated in both animal experiments and clinical trials. Besides, the predictive value of disease progression and complications by vHVPG will be also studied in cirrhotic patients with early-stage portal hypertension. vHVPG is expected to offer a novel approach for noninvasively evaluating cirrhotic portal hypertension, and plays an active role of improving quality of life and reducing risk of complications.

门脉高压作为肝硬化失代偿期的重要特征，常因出现晚期严重的并发症才被临床发现和诊断，建立一种安全无创、准确量化的早期门脉高压诊断技术已成为国内外该领域研究的迫切需求。本课题组在以往研究中初步探索了一种利用三维模型重建和流体力学分析量化门静脉压力的诊断技术。在本次项目申报中，我们首先提出了虚拟肝静脉压力梯度（virtual hepatic venous pressure gradient, vHVPG）概念，利用影像学控制软件重建精准的肝静脉-门静脉系统三维模型，利用有限元计算平台构建标准化的流体力学仿真分析流程，拟建立一种更具诊断优势的无创vHVPG新技术。此外，还将在动物实验和临床试验中明确vHVPG的诊断价值，通过入组早期门脉高压病例和随访观察来评估vHVPG对病情进展和并发症风险的预测价值。本研究有望为门脉高压的无创诊断提供新的思路，为改善患者生活质量和降低并发症发生风险起到积极作用。

门脉高压作为肝硬化失代偿期的重要特征，常因出现晚期严重的并发症才被临床发现和诊断，建立一种安全无创、准确量化的早期门脉高压诊断技术已成为国内外该领域研究的迫切需求。本研究中我们首先提出了虚拟肝静脉压力梯度（virtual hepatic venous pressure gradient, vHVPG）概念，利用影像学控制软件重建精准的肝静脉-门静脉系统三维模型，利用有限元计算平台构建标准化的流体力学仿真分析流程，建立一种更具诊断优势的无创vHVPG新技术。我们前瞻性从国内3个中心入组102例肝硬化病例（ClinicalTrials.gov 编号: NCT02842697），分析对照vHVPG和有创性HVPG，明确vHVPG和金标准HVPG显著相关（相关系数r=0.610，p<0.001）。在训练队列（n=29）和验证队列（n=73）中，vHVPG诊断临床显著性门脉高压的曲线下面积分别为0.83（95%CI：0.58-1.00）和0.89（95%CI：0.81-0.96）观察者间和观察者内一致性系数分别为0.88和0.96，说明该技术的稳定性和可重复性。 本研究结果有望为门脉高压的无创诊断提供新的思路，为改善患者生活质量和降低并发症发生风险起到积极作用。