经颈静脉肝内门体分流术后肝硬化再代偿发生及其预测因素分析  

The occurrence and predictive factors analysis of recompensation in post-TIPS patients with liver cirrhosis

作　　者：杨硕菲[1] 姚永杰 王预立 齐昊喆 李一男[1] 王韦仑 倪其泓[1] 陈佳佺[1] 郭相江[1] 赵意平[1] 叶猛[1] 薛冠华[1] 张岚[1] YANG Shuo-fei;YAO Yong-jie;WANG Yu-li(Department of Vascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200127

出　　处：《中国实用外科杂志》2024年第12期1393-1399,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82370497,No.82370495)。

摘　　要：目的 基于BavenoⅦ共识中的肝硬化“再代偿”标准,研究经颈静脉肝内门体分流术(TIPS)治疗失代偿期肝硬化病人术后“再代偿”发生率,并分析相关预测因素。方法 回顾性分析上海交通大学医学院附属仁济医院89例因食管胃底静脉曲张破裂出血或顽固性腹腔积液接受TIPS治疗的肝硬化门静脉高压病人的临床信息、术中情况、测量数据、实验室检查、影像学检查和12个月随访数据。利用单因素和多因素Logistic模型分析“再代偿”发生的预测因素,并进行相关亚组分析。结果 89例病人中46例于起病72 h内接受早期TIPS治疗。TIPS术后42.7%病人发生肝硬化“再代偿”。MELD评分<19、早期TIPS是TIPS术后发生肝硬化“再代偿”的独立预测因素。早期TIPS组术后肝硬化“再代偿”发生率(62.5%vs.23.8%,P<0.05)、肝性脑病发生率(10.0%vs.23.8%,P<0.05)、脾脏体积缩小比[(27.5±10.2)%vs.(10.9±5.5)%,P<0.01]、肝脏弹性值减少比[(4.5±1.2)%vs.(1.9±0.75)%,P<0.01]均显著优于非早期TIPS组。结论 MELD评分<19、早期TIPS是失代偿期肝硬化病人TIPS术后肝硬化“再代偿”的预测因素。相较于非早期TIPS,早期完成TIPS能够降低术后肝性脑病发生率,能够更好地促进脾脏缩小、改善肝脏弹性。Objective To study the occurrence rate of recompensation after transjugular intrahepatic portosystemic shunt(TIPS) treatment in patients with decompensated cirrhosis and analyze related predictive factors,based on the criteria of cirrhosis recompensation in the Baveno Ⅶ consensus.Methods A retrospective analysis was performed on89 cirrhotic patients with portal hypertension who underwent TIPS at Renji Hospital,affiliated with Shanghai Jiao Tong University School of Medicine,for esophagogastric variceal hemorrhage or refractory ascites.Clinical data,intraoperative findings,measurement results,laboratory tests,imaging studies,and 12-month follow-up information were reviewed.Univariate and multivariate Logistic models were used to analyze the predictive factors for the occurrence of recompensation and relevant subgroup analysis was performed.Results 46 of 89 patients received early TIPS treatment within 72 hours of onset.After TIPS,42.7% of patients developed“re-compensation”of liver cirrhosis.MELD score <19and early TIPS are independent predictive factors for the occurrence of“re-compensation”of liver cirrhosis after TIPS.The early TIPS group had significantly better rates of liver cirrhosis“re-compensation”(62.5% vs.23.8%,P<0.05),hepatic encephalopathy(10.0% vs.23.8%,P<0.05),spleen volume reduction ratio[(27.5±10.2)% vs.(10.9±5.5)%,P<0.01],and liver stiffness value reduction ratio[(4.5±1.2)% vs.(1.9±0.75)%,P<0.01]compared to the non-early TIPS group.Conclusion MELD score <19,early TIPS is a predictive factor for“re-compensation”of liver cirrhosis in postTIPS liver cirrhosis patients.Early TIPS can reduce the incidence of postoperative hepatic encephalopathy,increase the occurrence of “re-compensation” of cirrhosis,promote spleen shrinkage better,and improveliver elasticity.

关 键 词：肝硬化失代偿 肝硬化再代偿 早期经颈静脉肝内门体分流术 预测因素分析 

分 类 号：R6[医药卫生—外科学]