经颈静脉肝内门体分流术治疗肝硬化顽固性腹水的长期效果及预后因素分析

巨伟; 张博静; 韩国宏

doi:10.3969/j.issn.1001-5256.2016.08.019

经颈静脉肝内门体分流术治疗肝硬化顽固性腹水的长期效果及预后因素分析

DOI: 10.3969/j.issn.1001-5256.2016.08.019

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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出版历程
- 收稿日期: 2016-05-23
- 出版日期: 2016-08-20

Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors

Xijing Hospital of Digestive Diseases,Fourth Military Medical University

摘要

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...
- 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.
- liver cirrhosis /
- ascites /
- portasystemic shunt /
- transjugular intrahepatic /
- prognosis

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参考文献(29)

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