Membreno Fernando, Baez Arturo L, Pandula Reka, Walser Eric, Lau Daryl T-Y
Department of Internal Medicine, The University of Texas Medical Branch of Galveston, Texas, USA.
J Gastroenterol Hepatol. 2005 Mar;20(3):474-81. doi: 10.1111/j.1440-1746.2005.03601.x.
To compare the survival after transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal bleed, and to identify the factors predictive of survival.
Single tertiary center, retrospective-prospective study. Chart review was performed on all patients who underwent TIPS between 1993 and 2000 and prospective follow-up to determine survival. Pre- and post-TIPS clinical parameters were compared and Kaplan-Meier analysis was applied to compare the survival of both groups. Cox regression was used to identify predictors of survival after TIPS.
A total of 163 patients were included, 62 with refractory ascites and 101 with variceal bleed. Both groups had similar age (48.2 vs 48.9 year; P = 0.65) and consisted of predominantly Caucasians (51%) and Mexican-Americans (39%). More than 75% had chronic hepatitis C, alcoholic liver disease or both. Overall, the median survival was significantly better for variceal bleed (2 years) compared with refractory ascites (6 months) (P < 0.001). This survival advantage persisted in patients with Mayo risk score greater than 1.17. Transjugular intrahepatic portosystemic shunt improved severe ascites in 45% of patients (P = 0.03). Mayo risk score was highly predictive of survival after TIPS with a hazard ratio of 2.3, followed by Child-Pugh score, creatinine, albumin and ethnicity, with better survival among Mexican-Americans. Shunt dysfunction (31%) and hepatic encephalopathy (27%) were the most common complications of TIPS.
Patients who received TIPS for variceal bleed had significantly longer survival compared with those for refractory ascites. Mexican-Americans had an improved long-term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation.
比较经颈静脉肝内门体分流术（TIPS）治疗难治性腹水和静脉曲张破裂出血后的生存率，并确定预测生存的因素。
单中心三级回顾性前瞻性研究。对1993年至2000年间接受TIPS治疗的所有患者进行病历审查，并进行前瞻性随访以确定生存率。比较TIPS术前和术后的临床参数，并应用Kaplan-Meier分析比较两组的生存率。采用Cox回归分析确定TIPS术后生存的预测因素。
共纳入163例患者，其中62例为难治性腹水，101例为静脉曲张破裂出血。两组患者年龄相似（48.2岁对48.9岁；P = 0.65），主要为白种人（51%）和墨西哥裔美国人（39%）。超过75%的患者患有慢性丙型肝炎、酒精性肝病或两者兼有。总体而言，静脉曲张破裂出血患者的中位生存期（2年）明显优于难治性腹水患者（6个月）（P < 0.001）。这种生存优势在梅奥风险评分大于1.17的患者中持续存在。TIPS使45%的患者严重腹水得到改善（P = 0.03）。梅奥风险评分对TIPS术后生存具有高度预测性，风险比为2.3，其次是Child-Pugh评分、肌酐、白蛋白和种族，墨西哥裔美国人的生存率更高。分流功能障碍（31%）和肝性脑病（27%）是TIPS最常见的并发症。
接受TIPS治疗静脉曲张破裂出血的患者比治疗难治性腹水的患者生存期明显更长。与白种人相比，墨西哥裔美国人的长期生存率有所提高。这种生存种族差异的原因尚不清楚，值得进一步进行前瞻性评估。
