TIPS治疗肝硬化顽固性腹水的预后因素分析

原姗姗; 韩国宏; 柏明; 何创业; 殷占新; 王建宏; 祁兴顺; 杨志平; 张伟

TIPS治疗肝硬化顽固性腹水的预后因素分析

第四军医大学西京消化病医院

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中图分类号: R575.2
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- 出版日期: 2011-05-20

Prognostic factors in the prediction of survival following TIPS for cirrhosis and refractory ascites

摘要

摘要: 目的分析经颈静脉肝内门体分流术（TIPS）治疗肝硬化顽固性腹水患者的预后生存因素。方法回顾性收集我院25例肝硬化顽固性腹水患者的基本资料,术前7 d内相关生化指标,定期随访观察术后情况和生存期资料,通过Cox回归分析预后因素,以ROC确定预后因素的最佳界值。结果中位随访时间18个月（1～40个月）,6例患者在TIPS术后1年内死亡,无肝移植事件发生。3个月、1年累积生存率分别为84%、67%。Cox回归多因素分析示血清胆红素和血清肌酐水平能独立预测顽固性腹水患者的1年生存率。ROC分析血清胆红素46μmol/L（敏感性86%,特异性35%）、血清肌酐132μmol/L（敏感性83%,特异性33%）为最佳界值。Kaplan-Meier生存分析示胆红素<46μmol/L和≥46μmol/L时的1年生存率分别为92%和37%（P<0.001）,血清肌酐<132μmol/L和≥132μmol/L时的1年生存率分别为89%和43%（P<0.05）。结论血清胆红素≥46μmol/L和肌酐≥132μmol/L是预测肝硬化顽固性腹水患者1年生存率的因素,为即时判断患者预后提供临...
- 腹水 /
- 肝硬化 /
- 门体分流术,经颈静脉肝内
Abstract: Objective To analyse the prognostic factors of survival in patients with cirrhosis and refractory ascites treated with TIPS.Methods From January 2003 to February 2009, a cohort of 25 hospitalized patients with cirrhosis and refractory ascites treated with TIPS were retrospectively studied, and data were abstracted including baseline characteristics of patients and all biochemical variables within 7 days after being referred to our hospital.The major endpoints was death.Cox proportional hazards method was used to assess the prognostic value of the variables found to be significant in univariate analysis.For those variables, cut-off values according to ROC curves, were determined so as to get a sensitivity over 80%.Results The median time of follow up was 18 months (range 1-40 months) , 6 patients died and no liver transplantation was performed within the first year of follow up.The cumulative 3-month and 1-year survival rate were 84% and 67% respectively.Using multivariate analysis, only serum bilirubin and creatinine levels were independently associated with 1-year survival.According to ROC analysis, we selected the cut-off values of 46 μmol//L for serum bilirubin level (sensitivity = 86%, specificity = 35%) and 132 μmol//L for serum creatinine level (sensitivity = 83%, specificity = 33%) .In addition, Kaplan-Meier survival analysis demonstrated that the 1-year cumulative survival in patients with serum bilirubin level <46 μmol/L was 92% as compared to 37% in patients with serum bilirubin level ≥46 μmol/L (P<0.001) .The 1-year cumulative survival of patients with creatinine <132 μmol/L was 89% versus 43% for ≥132 μmol/L (P<0.05) .Conclusion A serum bilirubin level above 46 μmol/L and creatinine above 132 μmol/L are prognostic factors in patients with cirrhosis and refractory ascites treated with TIPS.This simple score could be used at bedside to help choosing the best therapeutic options.
- ascites /
- liver cirrhosis /
- portasystemic shunt

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参考文献(15)

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