肝移植术后食管静脉曲张患者的临床特点与风险因素

肝脏 ›› 2024, Vol. 29 ›› Issue (1): 44-46.

肝移植术后食管静脉曲张患者的临床特点与风险因素

向璐, 张利娟, 杨俊连, 张达利, 冯丹妮

100039 北京解放军总医院第五医学中心肝病医学部(向璐,张达利,冯丹妮),感染病医学部(张利娟,杨俊连)

收稿日期:2023-07-30 出版日期:2024-01-31 发布日期:2024-03-01
通讯作者: 张达利,Email: zhangdali20051019@163.com; 冯丹妮,Email: fdn_917_0y@163.com
作者简介:共同第一作者:张利娟

The characteristics and risk factors of esophageal varices in patients post-liver transplantation

XIANG Lu¹, ZHANG Li-juan², YANG Jun-lian²,ZHANG Da-li¹, FENG Dan-ni¹

1. Senior Department of Hepatology, the Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China;
2. Senior Department of Infectious Diseases, the Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China

Received:2023-07-30 Online:2024-01-31 Published:2024-03-01
Contact: ZHANG Da-li, Email: zhangdali20051019@163.com; FENG Dan-ni, Email: fdn_917_0y@163.com

摘要/Abstract

摘要： 目的探索肝移植术后食管静脉曲张患者的临床特点与风险因素。方法本研究为横断面研究。回顾性分析2011年7月至2021年10月于解放军总医院第五医学中心行胃镜检查的肝移植术后患者55例,其中存在食管静脉曲张患者26例,无食管静脉曲张患者29例。比较两组患者的临床特征,分析肝移植术后发生食管静脉曲张的影响因素。结果与没有食管静脉曲张患者比较,有静脉曲张患者的脾脏长度更长(117 mm比154 mm)、血小板水平更低(136 ×10⁹/L比87×10⁹/L)、总胆汁酸水平更高(6.0 μmol/L比24.5 μmol/L),差异均有统计学意义(均P<0.05)。脾脏长度是肝移植术后发生食管静脉曲张的独立危险因素(OR:1.063, 95% CI:1.01~1.12,P=0.031)。脾脏长度预测合并食管静脉曲张的ROC曲线下面积为0.790(95% CI:0.647~0.934,P=0.001), cutoff值为143mm,敏感度为65.0%,特异度为91.3%。结论脾脏长度是肝移植术后患者出现食管静脉曲张的独立危险因素,对食管静脉曲张有较好的预测效能。

关键词: 肝移植术后, 食管静脉曲张, 脾脏, 血小板, 胆汁酸

Abstract: Objective To explore the risk factors and characteristics of esophageal varices in patients post-liver transplantation (LT). Methods This is a cross-section study retrospectively analyzed the data of patients post-LT who had a gastroscopy at the General hospital of the 5th medical center of Chinese People's Liberation Army from July 2011 to October 2021. Patients post-LT were classified into patients with and without esophageal varices via gastroendoscopy. Results Fifty-five cases were included in this study, with 26 patients among them with esophageal varices, and 29 cases without esophageal varices. Compared with those patients without esophageal varices, patients with esophageal varices had three characteristics: longer spleen length (117 mm vs 154 mm, P=0.001), lower platelet counts (136×10⁹/L vs 87×10⁹/L, P=0.015), and higher total bile acid level (6.0 μmol/L vs 24.5 μmol/L, P=0.001). Spleen length (OR=1.063, 95%CI=1.01~1.12, P=0.031) was the independent risk factor associated with esophageal varices. The area under the ROC curve for esophageal varices was 0.790 (95%CI=0.647~0.934, P=0.001) at the cutoff value was 143mm, the sensitivity was 91.3%, and specificity was 91.3%. Conclusion Spleen length is the independent risk factor associated with esophageal varices and had good discriminable power for esophageal varices after LT.

Key words: Post-liver transplantation, Esophageal varices, Spleen, Platelet, Total bile acid

向璐, 张利娟, 杨俊连, 张达利, 冯丹妮. 肝移植术后食管静脉曲张患者的临床特点与风险因素[J]. 肝脏, 2024, 29(1): 44-46.

XIANG Lu, ZHANG Li-juan, YANG Jun-lian,ZHANG Da-li, FENG Dan-ni. The characteristics and risk factors of esophageal varices in patients post-liver transplantation[J]. Chinese Hepatolgy, 2024, 29(1): 44-46.

参考文献

[1] Ravaioli M, Lai Q, Sessa M, et al. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy[J]. J Hepatol, 2022,76(3):619-627.
[2] Belli LS, Duvoux C, Artzner T, et al. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS) [J]. J Hepatol, 2021,75(3):610-622.
[3] Unger LW, Berlakovich GA, Trauner M, et al. Management of portal hypertension before and after liver transplantation[J]. Liver Transpl, 2018,24(1):112-121.
[4] Korda D, Deak PA, Kiss G, et al. Management of portal hypertension after liver transplantation[J]. Transplant Proc, 2017,49(7):1530-1534.
[5] Gracia-Sancho J, Marrone G, Fernandez-Iglesias A. Hepatic microcirculation and mechanisms of portal hypertension[J]. Nat Rev Gastroenterol Hepatol, 2019,16(4):221-234.
[6] Pollok JM, Tinguely P, Berenguer M, et al. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference[J]. Lancet Gastroenterol Hepatol, 2023, 8(1):81-94.
[7] Gana JC, Serrano CA, Ling SC. Angiogenesis and portal-systemic collaterals in portal hypertension[J]. Ann Hepatol, 2016,15(3):303-13.
[8] Li T, Yang Z. Research progress of vasculopathy in portal hypertension[J]. World J Gastroenterol, 2005,11(39):6079-84.
[9] Jiang WT, Yang J, Xie Y, et al. Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism[J]. World J Gastroenterol, 2021,27(7):654-665.
[10] Sun X, Zhang A, Zhou T, et al. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial[J]. Hepatol Int, 2021,15(3):741-752.
[11] Balcar L, Semmler G, Pomej K, et al. Patterns of acute decompensation in hospitalized patients with cirrhosis and course of acute-on-chronic liver failure[J]. United European Gastroenterol J, 2021,9(4):427-437.
[12] Rogalski P, Rogalska-Plonska M, Wroblewski E, et al. Blood platelet function abnormalities in cirrhotic patients with esophageal varices in relation to the variceal bleeding history[J]. Scand J Gastroenterol, 2019,54(3):311-318.
[13] 冯丹妮, 张达利, 贺希, 等. 酒精性肝硬化的肝移植受者血小板减少的病例对照研究[J]. 肝脏, 2022, 5(27):540-556.
[14] Alvaro D, Caporaso N, Giannini EG, et al. Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia[J]. Eur J Clin Invest, 2021,51(6):e13508.
[15] Pablo Arab J, Barrera F, Arrese M. Bile acids and portal hypertension[J]. Ann Hepatol, 2017,16 Suppl 1:S83-S86.
[16] Sauerbruch T, Hennenberg M, Trebicka J, et al. Bile acids, liver cirrhosis, and extrahepatic vascular dysfunction[J]. Front Physiol, 2021, 12:718783.
[17] Fiorucci S, Distrutti E. Targeting the transsulfuration-H2S pathway by FXR and GPBAR1 ligands in the treatment of portal hypertension[J]. Pharmacol Res, 2016,111:749-756.