肝硬化患者TIPS术后死亡危险因素及不同评价系统的预测价值  

Risk factors of death and prognostic scores of patients with liver cirrhosis undergoing TIPS

作　　者：李凤惠[1] 张旭[1] 王涛[1] 梁静[1] 刘华[1] 高艳颖[1] Li Fenghui;Zhang Xu;Wang Tao;Liang Jing;Liu Hua;Gao Yanying(Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases Tianjin Institute of Hepatobiliary Disease Artificial Cell Engineering Technology Research Center,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院消化肝病科,天津市重症疾病体外生命支持重点实验室,天津市肝胆疾病研究所,天津市人工细胞工程技术研究中心,天津300170

出　　处：《国际生物医学工程杂志》2022年第2期93-98,111,共7页International Journal of Biomedical Engineering

基　　金：北京肝胆相照公益基金会项目(RGGJJ-2021-014)。

摘　　要：目的分析肝硬化患者行经颈静脉肝内门体分流术(TIPS)后2年内死亡的危险因素,探讨临床上常见的6种评价系统对TIPS术后死亡危险的预测价值。方法回顾分析132例接受TIPS治疗的肝硬化患者的临床资料。按照TIPS术后2年的临床结局,将患者分为死亡组及生存组。采用Logistic回归分析影响TIPS术后2年内的死亡相关危险因素。根据术前及术后1周时CTP、MELD、MELD-Na、BioCliM、FIB-4、ALBI评价系统的评分,应用受试者工作特征曲线(ROC)及其下面积(AUC)评价6种评价系统的死亡危险预测效能。结果在TIPS术后2年的随访期内,死亡组的年龄、尿素氮水平、血小板计数及术后1月发生肝性脑病的比例均高于生存组且血钠水平低于生存组(均P<0.05)。多因素分析显示,高龄、术后1月发生肝性脑病是影响患者死亡的独立危险因素(均P<0.05)。术后1周时,生存组和死亡组患者的CTP、MELD、MELD-Na评分的差异有统计学意义(均P<0.05);术后1周时,CTP、MELD、MELD-Na及ALBI评分ROC的AUC分别为0.685、0.721、0.805和0.658,最佳临界值分别为8.5、12.99、14.51和-1.52。结论高龄及TIPS术后1月发生肝性脑病是肝硬化患者TIPS术后2年内死亡的独立危险因素,术后1周进行CTP、MELD、MELD-Na、ALBI评价,能够对失代偿期肝硬化患者TIPS术后2年内的死亡危险进行预测,其中MELD-Na的预测效能最佳。Objective To analyze the risk factors of death within two years of the patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt(TIPS),and to explore the predictive value of 6 common clinical evaluation systems on the risk of death after TIPS.Methods TIPS clinical data from 132 patients with liver cirrhosis were analyzed retrospectively.According to the 2-year clinical outcome after TIPS,the patients were divided into the death group and the survival group.Logistic regression was used to analyze the risk factors of death within 2 years after TIPS.According to the scores of CTP,MELD,MELD Na,BioCliM,FIB-4,and ALBI evaluation systems,the prediction efficiency of death risk of the six evaluation systems was evaluated by using the receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results During the 2-year follow-up period after TIPS,the age,urea nitrogen level,platelet count,and proportion of hepatic encephalopathy in the death group were higher than those in the survival group one month after TIPS,and the serum sodium level was lower than those in the survival group(all P<0.05).Multivariate analysis showed that the elderly and hepatic encephalopathy one month after operation were independent risk factors for death(all P<0.05).At 1 week after the surgery,there were significant differences in CTP,MELD,and MELD-Na scores between the survival group and the death group(all P<0.05).One week after operation,the AUC of ROC of CTP,MELD,MELD-Na,and ALBI scores were 0.685,0.721,0.805,and 0.658 respectively,and the optimal critical values were 8.5,12.99,14.51 and-1.52 respectively.Conclusions The elderly and the occurrence of hepatic encephalopathy one month after TIPS are independent risk factors for the death of liver cirrhosis patients after TIPS.The evaluation of CTP,MELD,MELD-Na,and ALBI one week after TIPS can predict the death risk of decompensated liver cirrhosis patients within 2 years after TIPS,and MELD-Na has the best predictive effect.

关 键 词：肝硬化 经颈静脉肝内门体分流术 预后 危险因素 终末期肝病模型 

分 类 号：R657.3[医药卫生—外科学]