经颈静脉肝内门体分流术治疗肝硬化顽固性腹水临床疗效及预后因素分析

发布时间：2018-07-08 20:36

  本文选题：腹水 + 顽固性　； 参考：《重庆医科大学学报》2015年03期

【摘要】：目的:探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗肝硬化顽固性腹水的临床疗效及影响预后因素。方法:23例肝硬化顽固性腹水患者术后随访1~26月(平均9.7月),观察患者腹水缓解情况(腹水量)、临床血清学指标(血小板计数、白蛋白、总胆红素、凝血酶原时间、肌酐等)、生存率等。采用配对t检验、非参数检验分析术前术后临床血清学指标的变化情况,Kaplan-Merier方法计算生存率,术前危险因素预测3个月腹水疗效采用logistic回归分析,术前危险因素对术后生存情况的影响采用COX多因素回归模型分析,受试者工作曲线(receiver operating characteristic,ROC)及曲线下面积(area under the curve,AUC)判断最佳预测界值。结果:术后1年的各个随访期患者的腹水与术前比较明显改善,82.6%的患者术后1月腹水得到有效控制,52.4%患者在术后3月仅存少量腹水,术后6月在访的所有患者腹水均为少量。术后1周肝功能存在短期损害凝血酶原时间延长,中值(最小值,最大值)=19.6(14.0,28.7),Z=-2.419,P=0.016;Child-Pugh评分增加,x±s=9.87±1.71,t=-2.714,P=0.013;总胆红素升高,Z=-3.711,P=0.000,中值(最小值,最大值)=37.0(13.2,204.3),之后逐渐恢复。术后3个月、6个月及1年的累积生存率为95.5%、85.9%、78.1%。COX回归多因素分析显示血钠(P=0.027,HR=0.677,95%CI=0.479~0.956)、总胆红素(P=0.007,HR=1.049,95%CI=1.012~1.086)是影响预后的独立危险因素。运用ROC及AUC分析提示总胆红素AUC为0.676,95%CI为0.335~1.000,总胆红素37μmol/L(敏感性66.7%,特异性94.1%)为最佳预测界值。Kaplan-Merier生存率分析显示总胆红素≥37μmol/L及总胆红素37μmol/L时的1年生存率分别为25%、92.3%。结论:TIPS是治疗肝硬化顽固性腹水的有效方案,术后存在短期的肝功能损害;总胆红素≥37μmol/L是预测肝硬化顽固性腹水患者TIPS术后1年生存率的危险因素,可为术前判断患者预后提供临床依据。
[Abstract]:Objective: to investigate the clinical effect and prognostic factors of (transjugular intrahepatic portosystemic shunttips in the treatment of refractory ascites of liver cirrhosis by transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunttips). Methods Twenty three patients with refractory ascites of liver cirrhosis were followed up for 1 ~ 26 months (mean 9.7 months). The clinical serological parameters (platelet count, albumin, total bilirubin, prothrombin time), ascites remission (ascites volume) and clinical serological parameters (platelet count, albumin, total bilirubin, prothrombin time) were observed. Creatinine, etc.), survival rate, etc. The survival rate was calculated by Kaplan-Merier method with paired t test and nonparametric test. The preoperative risk factors were used to predict the effect of ascites for 3 months. Logistic regression analysis was used. The influence of preoperative risk factors on postoperative survival was analyzed by Cox multivariate regression model. The optimal predictive bounds were determined by the operating curve (receiver operating) and the area under the curve (area under the curveAUC). Results: the ascites of each follow-up period were significantly improved in 82.6% of the patients at 1 month after operation. 52.4% of the patients had only a small amount of ascites at 3 months after operation, and only a small amount of ascites were found in all the patients in 6 months after operation. At 1 week after operation, there were short-term damage to prothrombin time, the median value (minimum value, maximum value) was 19.6 (14.0 / 28.7) and the Child-Pugh score increased by x 卤s 9.87 卤1.71 ~ 1.71 ~ (-1) ~ 2.714 ~ 1 ~ 0. 013, the mean value (minimum value, maximum value) was 37.0 (13.2204.3), and the total bilirubin was increased by Z ~ (-3.711) P ~ (0.000), with a mean value (minimum value, maximum value) of 37.0 (13.2204.3). The cumulative survival rate at 3 months, 6 months and 1 year after operation was 95.55,85.9 and 78.1% respectively. Cox regression multivariate analysis showed that serum sodium (P0. 027) and total bilirubin (P0. 007) were independent risk factors for prognosis. The results of ROC and AUC analysis showed that the CI of total bilirubin was 0.3335 渭 mol / L, total bilirubin was 37 渭 mol / L (sensitivity 66.7%, specificity 94.1%). Kaplan-Merier survival rate analysis showed that the 1-year survival rate of total bilirubin 鈮，

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