食管胃底静脉曲张破裂出血患者急诊TIPS术后肝性脑病发生特征及危险因素分析

摘要/Abstract

摘要： 目的分析食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术(TIPS)后肝性脑病的发生特征及危险因素。方法回顾性分析2015年7月至2020年7月自贡市第三人民医院收治并在72 h内行TIPS治疗的102例肝硬化伴食管胃底静脉曲张破裂出血患者的临床资料。对所有患者进行术后跟踪随访6个月,根据是否发生肝性脑病将其分为肝性脑病组42例,非肝性脑病组60例。收集患者术前基本资料与生化指标并进行比较。采用单因素、多因素logistic回归分析食管胃底静脉曲张破裂出血急诊TIPS术后发生肝性脑病的危险因素。结果 102例患者中,肝性脑病发生率为41.18%(42/102),其中0~1级20例(47.62%),2级11例(26.19%),3级7例(16.675),4级5例(11.90%)。经单因素分析结果显示,食管胃底静脉曲张破裂出血患者TIPS术后肝性脑病与凝血时间、MELD评分、HVPG存在明显关系(P<0.05)。多因素logistic回归分析结果显示,MELD评分(OR=3.50,95%CI:1.70～7.10)、HVPG(OR=3.90,95%CI:1.58～9.67)为食管胃底静脉曲张破裂出血患者TIPS术后发生肝性脑病的独立危险因素(P<0.05)。结论食管胃底静脉曲张破裂出血患者急诊TIPS术后肝性脑病发生较高,MELD评分、HVPG是TIPS术后肝性脑病的独立危险因素。

关键词: 食管胃底静脉曲张, 破裂出血, 经颈静脉肝内门体分流术, 肝性脑病, 危险因素

Abstract: Objective To investigate the characteristics and risk factors of hepatic encephalopathy after emergent transjugular intrahepatic portosystemic shunt (TIPS) operation in patients with bleeding from esophageal and gastric varices (EGV).Methods The clinical data of 102 patients with liver cirrhosis accompanied by rupture of EGV who were admitted to the Third People’s Hospital of Zigong City from July 2015 to July 2020 and treated with TIPS within 72h were retrospectively analyzed. The patients were followed-up for 6 months. They were divided into 42 cases of hepatic encephalopathy (HE) group and 60 cases of non-hepatic encephalopathy (non-HE) group according to whether they occurred HE after operation. The baseline data and biochemical indicators of patients before TIPS surgery were collected and compared, followed by univariate and multivariate Logistic regression analysis for the risk factors of HE after TIPS.Results There were a total of 102 subjects enrolled in this study. Within them, 42 occurred HE, with 20 cases (47.62%) of grade 0~1, 11 cases of grade 2 (26.19%), 7 cases of grade 3 (16.675), and 5 cases of grade 4 (11.90%). The Results of univariate analysis showed that coagulation time, MELD score and HVPG in patients with EGV hemorrhage were associated with HE after TIPS (P<0.05). Multivariate logistic regression analysis showed that MELD score (OR=3.50, 95%CI: 1.70～7.10), HVPG (OR=3.90, 95%CI: 1.58～9.67) were independent risk factors for HE after TIPS operation in patients with ruptured EGV (P<0.05).Conclusion The incidence of HE after emergency TIPS is higher in patients with EGV bleeding. Among them, MELD score and HVPG are independent risk factors for HE after TIPS. Therefore, preoperative MELD score and HVPG can predict the risk of postoperative HE.

Key words: Esophageal and gastric varices, Rupture and bleeding, Transjugular intrahepatic portosystemic shunt, Hepatic encephalopathy, Risk factors

刘益, 周自忠, 刘刚, 徐海荣. 食管胃底静脉曲张破裂出血患者急诊TIPS术后肝性脑病发生特征及危险因素分析[J]. 肝脏, 2022, 27(6): 658-661.

LIU Yi, ZHOU Zi-zhong, LIU Gang, XU Hai-rong. The characteristics and risk factors of hepatic encephalopathy after emergent TIPS operation in patients with bleeding from esophageal and gastric varices[J]. Chinese Hepatolgy, 2022, 27(6): 658-661.

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