TIPS治疗食管胃底静脉曲张出血预后影响因素分析  

Prognostic factors of TIPS in treatment of gastroesophageal varices bleeding

作　　者：郑晖[1] 黄兢姚[1] 黄宁[1] 谢杭[1] 林俊清[1] 池桢[1] 柯坤 严乐业 杨维竹[1] ZHENG Hui;HUANG Jingyao;HUANG Ning;XIE Hang;LIN Junqing;CHI Zhen;KE Kun;YAN Leye;YANG Weizhu(Department of Interventional Radiology,Fujian Medical UniversityUnion Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院介入科,福建福州350001

出　　处：《中国介入影像与治疗学》2019年第5期270-274,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：福建省微创医学中心建设项目(No.[2017]171)

摘　　要：目的分析影响TIPS治疗食管胃底静脉曲张出血(EGVB)预后的因素。方法回顾性分析68例接受TIPS治疗的EGVB患者的资料。采用Kaplan-Meier方法计算术后累积生存率,不同患者间生存率比较采用log-rank检验。以Cox回归模型分析影响预后的因素,并以ROC曲线确定其预测经TIPS治疗后EGVB患者预后的最佳截点。结果 TIPS术后患者1、2、3年累积生存率分别为90.7%、82.2%和77.9%。患者年龄、术前血清白蛋白为影响TIPS治疗EGVB的预后因素。ROC曲线分析显示,以患者年龄、术前血清白蛋白评估EGVB患者TIPS术后1年生存预后的AUC分别为0.923(P=0.001)和0.183(P=0.011),年龄67.5岁为最佳截点。年龄≤67.5岁患者术后1年累积生存率明显高于年龄>67.5岁者(96.4%vs 64.3%,χ~2=10.785,P=0.001)。结论年龄及术前血清白蛋白是预测TIPS治疗EGVB患者生存情况的独立因素;年龄>67.5岁患者预后较差。Objective To analyze the prognostic factors of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of esophageal and gastric varices bleeding (EGVB). Methods A retrospective analysis was performed on 68 patients with EGVB who underwent TIPS.Kaplan-Meier method was used to calculate the cumulative survival after treatment,and the differences of cumulative survival were compared using log-rank test.Multivariate analysis of prognostic factors was carried out with Cox proportional hazards regression model,and ROC curve was used to determine the optimal cut-off value of prognostic factors.Results The 1-,2- and 3-year survival rate was 90.7%,82.2% and 77.9% respectively after TIPS procedures.Cox regression univariate and multivariate analysis showed that the age ( P =0.009) and preoperative serum albumin ( P =0.024) were independent prognostic factors.The area under the ROC curve of age for assessing whether the survival time more than 1 year was 0.923 ( P =0.001),while that of preoperative serum albumin was 0.183 ( P =0.011).Patient's age of 67.5 years was the optimal cut-off value.The 1-year cumulative survival rate of patients' aged ≤67.5 years was statistically significant higher than that of those older than 67.5 years (96.4% vs 64.3%,χ^2 =10.785,P =0.001).Conclusion Patients' age and preoperative serum albumin are independent predictors for the survival of EGVB after TIPS.Postoperative prognosis of patients' aged >67.5 years is unfavorable.

关 键 词：门体分流术 经颈静脉肝内 食管和胃静脉曲张 出血 预后 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]