经颈静脉肝内门体分流术后早期肝性脑病的危险因素  

Early hepatic encephalopathy after transjugular intrahepatic portosystemic shunt： the risk factors and long-time survival

作　　者：柏明[1] 韩国宏[1] 原姗姗[1] 殷占新[1] 何创业[1] 王建宏[1] 祁兴顺[1] 牛静[1] 郭文刚[1] 吴开春[1,2] 樊代明[1,2] 

机构地区：[1]第四军医大学西京消化病医院消化介入科,西安710032 [2]第四军医大学西京消化病医院超声科,西安710032

出　　处：《中华肝脏病杂志》2011年第7期498-501,共4页Chinese Journal of Hepatology

摘　　要：目的研究经颈静脉肝内门体分流术（TIPS）术后早期肝性脑病（HE）的危险因素，并观察术后HE与患者长期生存情况的相关性。方法收集2003年1月-2008年12月接受TIPS治疗食管胃底静脉曲张出血或顽固性腹水的患者。对术后3个月内有HE（术后早期HE组）和术后3个月内无HE（无术后早期HE组）的两组患者的临床特征进行单因素分析和多因素logistic回归分析，并对两组患者的生存情况进行分析比较。结果共收集190例患者资料，中位随访时间为30．5个月（四分位间距为30个月）。术前血清纤维蛋白酶原（OR=0．414，P=0．023）及Child-Pugh评分（OR=I．744，P=0．024）与术后早期HE相关。并且术后早期HE组患者与无术后早期HE组患者的3年累积生存率分别为44．9％（95％可信区间为53．5％～36．3％）和79．5％（95％可信区间为83．2％～75．7％）。结论TIPS术前高Child-Pugh评分及低血清纤维蛋白酶原的患者术后3个月内发生HE的可能性大。发生术后早期HE的患者比不发生术后早期HE患者长期累积生存率低。Objective To identify the risk factors of early post-TIPS hepatic encephalopathy （HE） and the long-time survival of patients with or without early post-TIPS HE. Methods Consecutive cirrhotic patients who underwent TIPS for variceal rebleeding or refractory ascites in our center from January 2003 to December 2008 were included in this study. More than 60 clinical characteristics were enrolled in univariate analysis and logistic regression analysis to define the risk factors of HE in 3 months after TIPS procedure （early post-TIPS HE）. The long-time survival of patients with or without early post-TIPS HE was compared by Cox regression with several covariates. Results According to our inclusion criteria, 190 patients were included. The median follow-up was 30.5 months. Lower serum concentration of fibrinogen and higher Child-Pugh score were the independent risk factors for suffering early post-TIPS HE. Patients without early post-TIPS HE after TIPS showed better prognosis than those with early post-TIPS HE after TIPS （P = 0.044）. Conclusion Patients with lower serum fibrinogen and higher Child-Pugh score before TIPS might be more probably attacked by early post-TIPS HE which indicated worse long-term survival.

关 键 词：门体分流术 经颈静脉肝内 肝性脑病 危险因素 

分 类 号：R575.2[医药卫生—消化系统]