摘要
目的探讨经颈静脉肝内门体分流术(TIPS)是否能改善肝硬化食管胃静脉曲张破裂出血(EGVB)合并肌肉减少症患者的预后。方法采用回顾性队列研究,选择2017年1月至2019年12月接受标准治疗或TIPS治疗的肝硬化EGVB患者,共464例。治疗后长期进行规律随访。主要结局是无移植生存期;次要终点为再出血、显性肝性脑病(OHE)。对所得数据进行统计学分析。连续变量资料组间比较使用t检验、Wilcoxon秩和检验,分类变量组间比较使用χ^(2)检验或Fisher确切概率法检验。结果纳入研究患者的年龄(55.27±13.86)岁,男性286例。203例患者合并肌肉减少症,261例患者为非合并肌肉减少症。中位随访时间为43个月;2组患者随访时间差异无统计学意义。整体队列中,TIPS组与标准治疗组患者的无移植生存期差异无统计学意义(HR=1.31,95%CI:0.97~1.78,P=0.08)。对于合并肌肉减少症的肝硬化患者,TIPS组无移植生存期较长(中位生存期:47.76个月与52.45个月,χ^(2)=4.09;HR=1.55,95CI:1.01~2.38,P=0.04)。对于非合并肌肉减少症的患者,2种治疗患者的无移植生存期差异无统计学意义(HR=1.22,95%CI:0.78~1.88,P=0.39)。无论是否合并肌肉减少症,TIPS均可延长患者的无再出血时间(非合并肌肉减少症患者:中位再出血时间分别为39.48个月与53.61个月,χ^(2)=18.68;HR=2.47,95CI:1.67~3.65,P<0.01;肌肉减少症患者:中位再出血时间分别为39.91个月与50.68个月,χ^(2)=12.36;HR=2.20,95CI:1.42~3.40,P<0.01)。相较标准治疗组,TIPS增加患者的1年OHE发生率(肌肉减少症患者:6.93%与16.67%,χ^(2)=3.87,P=0.049;非合并肌肉减少症患者:2.19%与9.68%,χ^(2)=8.85,P=0.01);2种治疗组之间长期OHE发生率的差异无统计学意义(P值均>0.05)。结论在合并肌肉减少症的肝硬化伴EGVB患者的二级预防中,相较标准治疗,TIPS可明显延长患者的无移植生存期;而在非合并肌肉减少症的肝硬化EGVB患者中其优势并不突出�
Objective To explore whether transjugular intrahepatic portosystemic shunt(TIPS)can improve the prognosis of esophagogastric variceal bleeding(EGVB)combined with sarcopenia in cirrhotic patients.Methods A retrospective cohort study was performed.A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected.Regular follow-up was performed for the long-term after treatment.The primary outcome was transplantation-free survival.The secondary endpoints were rebleeding and overt hepatic encephalopathy(OHE).The obtained data were statistically analyzed.The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups.Theχ^(2)test,or Fisher's exact probability test,was used to compare categorical variables between groups.Results The age of the included patients was 55.27±13.86 years,and 286 cases were male.There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia.The median follow-up period was 43 months.The two groups had no statistically significant difference in follow-up time.There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort(HR=1.31,95%CI:0.97-1.78,P=0.08).The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival(median survival:47.76 vs.52.45,χ^(2)=4.09;HR=1.55,95CI:1.01~2.38,P-0.04).There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia(HR=1.22,95%CI:0.78~1.88,P=0.39).Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination(patients without combined sarcopenia:median rebleeding time:39.48 vs.53.61,χ^(2)=18.68;R=2.47,95CI:1.67~3.65,P<0.01;patients with sarcopenia:median rebleeding time:39.91 vs.50.68,χ^(2)=12.36;HR=2.20,95CI:1.42~3.40,P<0.01).TIPS patients had an increased 1-year OHE incidence rate compared to the standard
作者
王曦旋
张明
尹晓春
高波
顾丽红
李炜
肖江强
张松
张玮
张鑫
邹晓平
王雷
诸葛宇征
张峰
Wang Xixuan;Zhang Ming;Yin Xiaochun;Gao Bo;Gu Lihong;Li Wei;Xiao Jiangqiang;Zhang Song;Zhang Wei;Zhang Xin;Zou Xiaoping;Wang Lei;Zhuge Yuzheng;Zhang Feng(Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210000,China;Second Clinical Medical School,Medical School,Southeast University,Nanjing 210000,China;Department of Clinical Nutrition,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210000,China;Department of Radiology,Afiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210000,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2024年第8期744-752,共9页
Chinese Journal of Hepatology
基金
国家自然科学基金(81900552)
南京市卫生科学技术发展专项基金重点项目(ZKX19015)
南京市卫生科技发展专项资金优秀青年基金项目(JQX20005)
南京大学医学院附属鼓楼医院临床试验项目(2022-LCYJ-MS-13)。
关键词
肝硬化
食管胃静脉曲张出血
肌肉减少症
经颈静脉肝内门体分流术
治疗
Liver cirrhosis
Esophagogastric variceal bleeding
Sarcopenia
Transjugular intrahepatic portosystemic shunt
Therapeutic
