经颈静脉肝内门腔分流术后肝功能随访及危险因素分析  

Follow-up and risk factors analysis of liver function after transjugular intrahepatic portosystemic shunt

作　　者：谭卿 王江云[1] 彭崎峰 刘芳[1] 高一平 苏时钦 郭备 赵剑波[1] Tan Qing;Wang Jiangyun;Peng Qifeng;Liu Fang;Gao Yiping;Su Shiqin;Guo Bei;Zhao Jianbo(Division of Vascular and Interventional Radiology,Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangdong Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普外科血管与介入专科,广州510515

出　　处：《中华介入放射学电子杂志》2022年第1期50-55,共6页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的观察经颈静脉肝内门腔分流术(TIPS)后患者肝功能的变化情况,以及TIPS术后肝损伤的危险因素分析。方法收集2017年4月至2019年8月南方医科大学南方医院收治的肝硬化合并门静脉高压患者198例,均成功实施TIPS,随访术后1、3、6、12、18和24个月的终末期肝病模型(MELD)评分以及Child-Pugh评分。采用非条件Logistic回归模型筛选出术后重度肝损伤的独立危险因素,绘制ROC曲线图形,计算AUC以判断各危险因素的预测效能。结果MELD评分从术后1个月开始显著升高(13.8±3.9 vs 11.0±3.4;P<0.001),之后逐渐降低至术后1年又缓慢回升,但始终明显高于术前基线水平。Child-Pugh评分从术后6个月开始逐渐降低,在术后1年降至最低值(6.6±1.3 vs 6.9±1.4;P=0.027),之后逐渐回升至术前基线水平。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素(OR=4.452,P=0.012;OR=1.320,P=0.001;OR=1.509,P=0.033),术前MELD评分和Child-Pugh评分的cut-off值分别为13.5、7.5。结论TIPS因机械性损伤和肝内门腔分流,导致术后肝功能不同程度受损。原发性肝癌、术前MELD评分以及术前Child-Pugh评分是TIPS术后1年重度肝损伤的独立危险因素。Objective To investigate the changes of liver function after transjugular intrahepatic portosystemic shunt(TIPS),and to analyze the risk factors of liver injury after TIPS.Methods A total of 198 patients with portal hypertension due to cirrhosis admitted to Nanfang Hospital of Southern Medical University from Apr.2017 to Aug.2019 were enrolled in this study,and received TIPS successfully.Model for end-stage liver disease(MELD)score and Child-Pugh score were followed up at 1,3,6,12,18 and 24 months after TIPS.Unconditional Logistic regression model was used to screen out the independent risk factors of postoperative severe liver injury.Receiver operating characteristic curve was plotted and the area under it was calculated to evaluate the diagnose performance.Results MELD score increased significantly from 1 month after TIPS(13.8±3.9 vs 11.0±3.4;P<0.001),then gradually decreased until 1 year after TIPS and slowly increased again,but it was always significantly higher than preoperative baseline level.Child-Pugh score gradually decreased from 6 months after TIPS,and reached the lowest value at 1 year after TIPS(6.6±1.3 vs 6.9±1.4;P=0.027),then slowly returned to preoperative baseline level.Liver cancer,preoperative MELD score and Child-Pugh score were independent risk factors for severe liver injury at 1 year after TIPS(OR=4.452,P=0.012;OR=1.320,P=0.001;OR=1.509,P=0.033),the cut-off values of preoperative MELD score and Child-Pugh score were 13.5 and 7.5,respectively.Conclusions Liver function after TIPS was impaired to varying degrees due to mechanical injury and intrahepatic portosystemic shunt.Liver cancer,preoperative MELD score and Child-Pugh score were independent risk factors for severe liver injury at 1 year after TIPS.

关 键 词：经颈静脉肝内门腔分流术 肝功能 重度肝损伤 危险因素 

分 类 号：R575.2[医药卫生—消化系统]