Gamanagatti Shivanand R, Patel Arpan H, Kedia Saurabh, Nayak Baibaswata, Gunjan Deepak, Ranjan Gyan, Paul Shashi B, Acharya Subrat K
aDepartment of Gastroenterology bDepartment of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India cDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Eur J Gastroenterol Hepatol. 2017 Oct;29(10):1174-1182. doi: 10.1097/MEG.0000000000000945.
BACKGROUND/AIM: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in Budd-Chiari syndrome (BCS) based on current data. Our objective was to evaluate outcomes and assess prognostic factors in BCS patients undergoing TIPS.
In this retrospective analysis of a propectively maintained database, all consecutive BCS patients undergoing TIPS from September 2010 to February 2017 were included. Complete response after TIPS was defined as resolution of symptoms (ascites/pedal edema) with no requirement of diuretics at the end of 4 weeks. The Cox proportional hazard regression model was used to assess predictors of outcome and complications.
Eighty patients with BCS who underwent TIPS were included; 40 (50%) were male. The mean age at onset of symptoms was 24.2±8.7 years. The median (range) follow-up was 660 (2-2400) days. The 1-, 3-, and 5-year rates for TIPS stent patency were 89, 81, and 81%, respectively. Cumulative encephalopathy-free rates were 91, 86, and 86%, respectively, and survival rates were 93, 89, and 84%, respectively. Eight (10.0%) patients died during follow-up, five within the first year (three of these five had incomplete response). On univariate analysis, serum bilirubin, response to intervention, serum creatinine, Child class, model for end-stage liver disease, and All India Institute of Medical Sciences-hepatic venous outflow tract obstruction score were significantly different between survivors and nonsurvivors. On multivariate analysis, response to therapy after TIPS (hazard ratio: 8.37; 95% confidence interval: 1.60-43.82) was independently associated with mortality. The 1-year survival was 97% in patients with complete response, compared with 59% in those with incomplete response (P<0.004).
Incomplete symptom response after TIPS is associated with poor outcome and can be used for selection of patients for liver transplantation.
背景/目的：基于目前的数据，经颈静脉肝内门体分流术（TIPS）是布加综合征（BCS）的首选治疗方法。我们的目的是评估接受TIPS治疗的BCS患者的治疗效果并分析预后因素。
在对一个前瞻性维护数据库的回顾性分析中，纳入了2010年9月至2017年2月期间所有连续接受TIPS治疗的BCS患者。TIPS术后完全缓解定义为4周结束时症状（腹水/足部水肿）消失且无需使用利尿剂。采用Cox比例风险回归模型评估预后和并发症的预测因素。
纳入80例接受TIPS治疗的BCS患者；40例（50%）为男性。症状出现时的平均年龄为24.2±8.7岁。中位（范围）随访时间为660（2 - 2400）天。TIPS支架1年、3年和5年通畅率分别为89%、81%和81%。无肝性脑病累积发生率分别为91%、86%和86%，生存率分别为93%、89%和84%。8例（10.0%）患者在随访期间死亡，5例在第1年内死亡（这5例中有3例缓解不完全）。单因素分析显示，幸存者和非幸存者之间血清胆红素、干预反应、血清肌酐、Child分级、终末期肝病模型以及全印度医学科学研究所肝静脉流出道梗阻评分存在显著差异。多因素分析显示，TIPS术后治疗反应（风险比：8.37；95%置信区间：1.60 - 43.82）与死亡率独立相关。完全缓解患者的1年生存率为97%，而缓解不完全患者为59%（P<0.004）。
TIPS术后症状缓解不完全与预后不良相关，可用于选择肝移植患者。
