经颈静脉肝内门体分流术后发生显性肝性脑病、死亡危险因素分析
Analysis of risk factors for overt hepatic encephalopathy and death after transjugular intrahepatic portosystemic shunt
占魁 1张天佑 1黄水根 1欧书强 1辛力 1邬飞源 1邱艳 1张宁1
作者信息
- 1. 萍乡市第二人民医院肝病科,江西 萍乡 337000
- 折叠
摘要
目的 探讨肝硬化门脉高压患者经颈静脉肝内门体分流术(TIPS)后发生显性肝性脑病(OHE)及死亡的危险因素.方法 回顾性选取40例肝硬化门脉高压行TIPS患者,术后随访3～41月,中位随访时间20.36月.将术后发生肝性脑病(HE)分为OHE组(20例)及非OHE组(20例);根据患者术后生存状态,分为死亡组(11例)及生存组(29例).详细记录所有患者性别、年龄、术前身高、体质量,总胆红素、白蛋白、谷丙转氨酶、谷草转氨酶、肌酐、国际标准化比值(INR)、凝血酶原时间、血糖、白细胞、血红蛋白、血小板实验室检测,术前有无糖尿病,有无门脉血栓,同时进行Child评分、终末期肝病模型(MELD)评分.对2组间分别进行统计学分析得出HE、死亡的相关危险因素.结果 TIPS后发生OHE 50%,分析得出年龄[风险比(HR)1.115,95%置信区间(CI)1.007～1.234,P=0.036]、白蛋白(HR 0.776,95%CI 0.627～0.960,P=0.020)是TIPS后发生OHE的独立危险因素.绘制受试者工作特征(ROC)曲线,年龄的曲线下面积(AUC)0.733,白蛋白AUC 0.784.TIPS后发生死亡率27.5%,分析得出白蛋白(HR 0.660,95%CI 0.453～0.961,P=0.030)、肌酐(HR 1.031,95%CI 1.001～1.062,P=0.044)、谷草转氨酶(HR 1.074,95%CI 1.013～1.139,P=0.018)是TIPS后发生死亡的独立危险因素.绘制ROC曲线,白蛋白AUC 0.716,肌酐AUC 0.762,谷草转氨酶AUC 0.710.结论 术后发生OHE与年龄呈正相关,与白蛋白呈负相关,术后发生死亡危险与肌酐、谷草转氨酶呈正相关,与白蛋白呈负相关.
Abstract
Objective To investigate the risk factors of overt hepatic encephalopathy(OHE)and death in cirrhotic portal hyperten-sion patients after transjugular intrahepatic portosystemic shunt(TIPS).Methods A retrospective selection was conducted on 40 patients with cirrhotic portal hypertension who underwent TIPS.The follow-up time was 3-41 months,median follow-up time was 20.36 months.The postoperative hepatic encephalopathy(HE)were divided into OHE group(20 cases)and non-OHE group(20 cases)and were further divided into death group(11 cases)and survival group(29 cases)according to their postoperative survival status.Gender,age,preoperative height,weight,total bilirubin,albumin,alanine aminotransferase,aspartate aminotransferase,creatinine,international normalized ratio(INR),prothrombin time,blood glucose,white blood cells,hemoglobin and platelet of all patients were recorded in detail,as well as whether they had diabetes and portal thrombosis before surgery.Child score and model for end-stage liver disease(MELD)score were also performed.The related risk factors of HE and death were obtained by statistical analysis of the two groups.Results The incidence rate of OHE after TIPS was 50%.The analysis revealed that age[hazard ratio(HR)1.115,95%confidence interval(CI)1.007-1.234,P=0.036]and albumin(HR 0.776,95%CI 0.627-0.960,P=0.020)were independent risk factors for OHE after TIPS.The receiver operating characteristic(ROC)curves were drawn with area under the curve(AUC)of 0.733 for age and AUC of 0.784 for albumin.The mortality rate after TIPS was 27.5%,and the analysis indicated that albumin(HR 0.660,95%CI 0.453-0.961,P=0.030),creatinine(HR 1.031,95%CI 1.001-1.062,P=0.044),and aspartate aminotransferase(HR 1.074,95%CI 1.013-1.139,P=0.018)were independent risk factors for death after TIPS.The ROC curves were drawn with AUC of 0.716 for albumin,AUC of 0.762 for creatinine,and AUC of 0.710 for aspartate aminotransferase.Conclusion Postoperative OHE is posi-tively correlated with age and negatively correlated with albumin.Furthermore,the risk of postoperative death is positively correlated with creatinine and aspartate aminotransferase and negatively correlated with albumin.
关键词
肝硬化/门脉高压/经颈静脉肝内门体分流术/肝性脑病/死亡/危险因素Key words
liver cirrhosis/portal hypertension/transjugular intrahepatic portosystemic shunt/hepatic encephalopathy/death/risk factors引用本文复制引用
出版年
2025
NETL
NSTL
万方数据