Effect of portal pressure gradient reduction on outcomes after transjugular intrahepatic portosystemic shunt in portal hypertension patients  

作　　者：Zhi-Bin Wang Bing Zhu Ming-Ming Meng Yi-Fan Wu Yu Zhang Dong-Ze Li Hua Tian Fu-Chuan Wang Yi-Fan Lv Qiu-Xia Ye Fu-Quan Liu 

机构地区：[1]Center for Minimally Invasive Treatment of Liver Diseases,Beijing Shijitan Hospital,Capital Medical University,Beijing 100080,China [2]Center for Diagnosis and Treatment of Hepatic Vascular Diseases,The Fifth Medical Center of Chinese People’s Liberation Army General Hospital,Beijing 100071,China

出　　处：《World Journal of Hepatology》2025年第3期102-115,共14页世界肝病学杂志(英文)

基　　金：Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.

摘　　要：BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.

关 键 词：Liver cirrhosis Portal hypertension Transjugular intrahepatic portosystemic shunt Hepatic encephalopathy Liver failure CARCINOMA HEPATOCELLULAR 

分 类 号：R57[医药卫生—消化系统]