Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study  

作　　者：Xi-Xuan Wang Xiao-Chun Yin Li-Hong Gu Hui-Wen Guo Yang Cheng Yan Liu Jiang-Qiang Xiao Yi Wang Wei Zhang Xiao-Ping Zou Lei Wang Ming Zhang Yu-Zheng Zhu-Ge Feng Zhang 

机构地区：[1]Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210000,Jiangsu Province,China [2]Medical School,Southeast University,Nanjing 210000,Jiangsu Province,China [3]Department of Gastroenterology,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu Province,China

出　　处：《World Journal of Gastroenterology》2023年第22期3519-3533,共15页世界胃肠病学杂志（英文版）

基　　金：Supported by the National Natural Science Foundation of China,No.81900552;Nanjing Health Science,Technology Development Special Fund Project-Key project,No.ZKX19015;Outstanding Youth Fund project,No.JQX20005;Funding for Clinical Trials from the Affiliated Drum Tower Hospital,Medical School of Nanjing University,No.2022-LCYJ-MS-13.

摘　　要：BACKGROUND It is controversial whether transjugular intrahepatic portosystemic shunt(TIPS)placement can improve long-term survival.AIM To assess whether TIPS placement improves survival in patients with hepaticvenous-pressure-gradient(HVPG)≥16 mmHg,based on HVPG-related risk stratification.METHODS Consecutive variceal bleeding patients treated with endoscopic therapy+nonselectiveβ-blockers(NSBBs)or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019.HVPG measurements were performed before therapy.The primary outcome was transplant-free survival;secondary endpoints were rebleeding and overt hepatic ence-phalopathy(OHE).RESULTS A total of 184 patients were analyzed(mean age,55.27 years±13.86,107 males;102 in the EVL+NSBB group,82 in the covered TIPS group).Based on the HVPG guided risk stratification,70 patients had HVPG<16 mmHg,and 114 patients had HVPG≥16 mmHg.The median follow-up time of the cohort was 49.5 mo.There was no significant difference in transplant-free survival between the two treatment groups overall(hazard ratio[HR],0.61;95%confidence interval[CI]:0.35-1.05;P=0.07).In the high-HVPG tier,transplant-free survival was higher in the TIPS group(HR,0.44;95%CI:0.23-0.85;P=0.004).In the low-HVPG tier,transplantfree survival after the two treatments was similar(HR,0.86;95%CI:0.33-0.23;P=0.74).Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier(P<0.001).The difference in OHE between the two groups was not statistically significant(P=0.09;P=0.48).CONCLUSION TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mmHg.

关 键 词：Hepatic venous pressure gradient Transjugular intrahepatic portosystemic shunts CIRRHOSIS Variceal rebleeding SURVIVAL 

分 类 号：R575[医药卫生—消化系统]