Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors
-
摘要: 目的评估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长期效果和预后因素分析。方法回顾性收集2009年1月-2014年6月于第四军医大学西京消化病医院住院并接受TIPS治疗的57例肝硬化顽固性腹水患者的临床资料,并定期对所有患者进行电话随防,主要监测指标是实验室检查及腹部B超、CT等影像学检查,同时了解腹水改善和生存的情况。计数资料组间比较采用χ2检验,采用Kaplan-Meier法估计累积生存概率及其他累积概率,采用log-rank检验比较不同组别生存率,运用Cox回归分析预后因素,以受试者工作特征曲线(ROC)及曲线下面积(AUC)确定预后因素的最佳界值。结果 TIPS术后1年腹水缓解率为93%,1年生存率为60%,2年生存率为43%。Cox回归多因素分析示Child-Pugh评分[HR(风险比)=1.268,95%可信区间(95%CI):1.0091.594,P=0.042]和尿素氮(HR=1.143,95%CI:1.0341.264,P=0.009)是顽固性腹水患者TIPS术后1年生存率的预测因素。ROC分析示:Chil...
-
关键词:
- 肝硬化 /
- 腹水 /
- 门体分流术,经颈静脉肝内 /
- 预后 /
- 因素分析,统计学
Abstract: Objective To investigate the long- term therapeutic effect of transjugular intrahepatic portosystemic shunt( TIPS) in patients with intractable cirrhotic ascites and prognostic factors. Methods A retrospective analysis was performed for the clinical data of 57 patients with intractable cirrhotic ascites who were received TIPS in our hospital from January 2009 to June 2014. Regular telephone follow- up was performed in all patients. Laboratory testing results and abdominal ultrasound and CT findings were examined. The improvement in ascites and survival were evaluated. The χ2test was applied for comparison of categorical data between groups. The Kaplan- Meier method was used to calculate the cumulative probability of survival and other cumulative probabilities,the log- rank test was used for survival difference analysis,the Cox regression model was used to analyze prognostic factors,and the receiver operating characteristic curve( ROC) and the area under the curve( AUC) were used to determine the optimal cut- off values of prognostic factors. Results The 1- year ascites remission rate after TIPS was93%,and the 1- and 2- year survival rates were 60% and 43%,respectively. The multivariate Cox regression analysis showed that Child-Pugh score( HR = 268,95% CI: 1. 009- 1. 594,P = 0. 042) and urea nitrogen( HR = 1. 143,95% CI: 1. 034- 1. 264,P = 0. 009,) were predictive factors for 1- year survival rate after TIPS in patients with intractable cirrhotic ascites. The area under the ROC curve of Child-Pugh score was 0. 699( P = 0. 011,95% CI: 0. 558- 0. 840),and the optimal cut- off value of Child- Pugh score was 8,with a sensitivity of75% and a specificity of 67%. The Kaplan- Meier survival analysis demonstrated that the 1- year survival rates of patients with Child- Pugh scores of ≤8 and > 8 were 82% and 38%,respectively( χ2= 10. 888,P = 0. 001). Conclusion TIPS is safe and effective in the treatment of intractable ascites,and Child- Pugh score ≤8 is a predictive factor for 1- year survival rate in such patients.-
Key words:
- liver cirrhosis /
- ascites /
- portasystemic shunt /
- transjugular intrahepatic /
- prognosis
-
[1] GINS P,CRDENAS A,ARROYO V,et al.Management of cirrhosis and ascites[J].N Engl J Med,2004,350(16):1646-1654. [2] GINS P,ANGELI P,LENZ K,et al.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397-417. [3] RUNYON BA.Management of adult patients with ascites due to cirrhosis:update 2012[J].Hepatology,2013:1-25. [4]SANYAL AJ,GENNING C,REDDY KR,et al.The North American study for the treatment of refractory ascite[J].Gastroenterology,2003,124(3):634-641. [5]LEBREC D,GIUILY N,HADENGUE A,et al.Transjugular intrahepatic portosystemic shunt:comparison with paracentesis in patients with cirrhosis and refractory ascites:a randomized trial[J].J Hepatol,1996,25(12):135-144. [6] RSSLE M,OCHS A,GULBERG V,et al.A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites[J].N Engl J Med,2000,342(6):1701-1707. [7]GINS P,URIZ J,CALAHORRA B,et al.Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J].Gastroenterology,2002,123(6):1839-1847. [8] SALERNO F,MERLI M,RIGGIO O,et al.Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J].Hepatology,2004,40(8):629-635. [9] OCHS A,ROSSLE M,HAAG K,et al.The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites[J].N Engl J Med,1995,332(5):1192-1197. [10] SAAB S,NIETO JM,LEWIS SK,et al.TIPS versus paracentesis for cirrhotic patients with refractory ascites[J].Cochrane Database Syst Rev,2006,4(4):CD004889. [11]WONG F,SNIDERMAN K,LIU P,et al.The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt[J].Gastroenterology,1997,112(3):899-907. [12]TAN HK,JAMES PD,WONG F,et al.Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion[J].J Gastroenterol Hepatol,2015,30(2):389-395. [13] CHUTAPUTTI A.Management of refractory ascites and hepatorenal syndrome[J].J Gastroenterol Hepatol,2002,17(4):456-461. [14]SENZOLO M,CHOLONGITAS E,TIBBALL J,et al.Transjugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome[J].Eur J Gastroenterol Hepatol,2006,18(11):1143-1150. [15]BOYER TD.Transjugular intrahepatic portosystemic shunt:current status[J].Gastroenterology,2003,124(5):1700-1710. [16]ALBILLOS A,BANARES R,GONZALEZ M,et al.A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites[J].J Hepatol,2005,43(6):990-996. [17]SALERNO F,CAMMA C,ENEA M,et al.Transjugular intrahepatic portosystemic shunt for refractory ascites:a meta-analysis of individual patient data[J].Gastroenterology,2007,133(3):825-834. [18] NARAHARA Y,KANAZAWA H,FUKUDA T,et al.Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function:a prospective randomized trial[J].J Gastroenterol,2011,46(1):78-85. [19]BAI M,QI XS,YANG ZP,et al.TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:an updated meta-analysis[J].World J Gastroenterol,2014,20(10):2704-2714. [20]FORREST EH,STANLEY AJ,REDHEAD DN,et al.Clinical response after transjugular intrahepatic portosystemic stent shunt insertion for refractory ascites in cirrhosis[J].Aliment Pharmacol Ther,1996,10(5):801-806. [21]DESCHNES M,DUFRESNE MP,BUI B,et al.Predictors of clinical response to transjugular intrahepatic portosystemic shunt(TIPS)in cirrhotic patients with refractory ascites[J].Am J Gastroenterol,1999,94(5):1361-1365. [22]BUREAU C,MTIVIER S,D'AMICO M,et al.Serum bilirubin and platelet count:a simple predictive model for survival in patients with refractory ascites treated by TIPS[J].J Hepatol,2011,54(5):901-907. [23]HA MEL B,GUILLAUDA O,ROMAN S,et al.Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt:from the liver to the kidney[J].Dig Liver Dis,2014,46(8):1001-1007. [24] PARVINIAN A,BUI JT,KNUTTINEN MG,et al.Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites[J].Diagn Interv Radiol,2014,20(1):58-64. [25]TAKI Y,KANAZAWA H,NARAHARA Y,et al.Predictive factors for improvement of ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites[J].Hepatol Res,2014,44(8):871-877. [26]SERSTT,GUSTOT T,RAUTOU PE,et al.Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites[J].J Hepatol,2012,57(2):274-280. [27]HARROD-KIM P,SAAD WE,WALDMAN D,et al.Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites[J].J Vasc Interv Radiol,2006,17(10):1605-1610. [28]SANYAL AJ.Pros and cons of TIPS for refractory ascites[J].J Hepatol,2005,43(6):924-925. [29]WU X,DING W,CAO J,et al.Clinical outcome using the fluency stent graft for transjugular intrahepatic portosystemic shunt in patients with portal hypertension[J].Am Surg,2013,79(3):305-312.
本文二维码
计量
- 文章访问数: 2368
- HTML全文浏览量: 16
- PDF下载量: 486
- 被引次数: 0