经颈静脉肝内门体分流术
医学
胃肠病学
内科学
肝性脑病
门脉高压
危险系数
回顾性队列研究
置信区间
门静脉压
肝硬化
外科
作者
Chaoyang Wang,Yingliang Wang,Jianbo Zhao,Chongtu Yang,Xiaoli Zhu,Huanzhang Niu,Junhui Sun,Bin Xiong
出处
期刊:Heliyon
[Elsevier]
日期:2024-01-01
卷期号:10 (1): e23455-e23455
标识
DOI:10.1016/j.heliyon.2023.e23455
摘要
PurposeTo assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on clinical outcomes and liver histology in patients with hepatic sinusoidal obstruction syndrome (HSOS) caused by pyrrolizidine alkaloids (PA), and compare these results with those of patients who received supportive treatment alone.Materials and methodsFrom June 2015 to August 2022, 164 patients diagnosed with PA-HSOS in six tertiary care centers were retrospectively included in this study and divided into TIPS group (n = 69) and supportive treatment (ST) group (n = 95). The main endpoint was to determine whether TIPS placement could improve survival in PA-HSOS patients. The clinical symptoms associated with portal hypertension were also evaluated in this study. Additionally, a small TIPS-subgroup of 7 patients received liver biopsies before and after TIPS for histological analysis.ResultsThe incidence of death was markedly lower in the TIPS group than in the ST group (log-rank p = 0.026). Multivariate Cox model revealed that group assignment (hazard ratio (HR) 5.146; 95 % confidence interval (CI) 1.587–16.687; p = 0.006), total bilirubin (HR 1.029; 95 % CI 1.020–1.038; p < 0.001), and INR (HR 13.291; 95 % CI 3.637–48.566; p < 0.001) were independent predictors for mortality. In addition, TIPS placement reduced the risk of complications associated with portal hypertension but did not increase the rate of overt hepatic encephalopathy (log-rank p = 0.731). Furthermore, six of 7 TIPS patients receiving liver biopsies improved after TIPS placement, and one patient developed fibrosis.ConclusionsTIPS placement decreased the mortality and risk of complications associated with portal hypertension. Histological evaluation in a few patients showed a potential improvement by TIPS.
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