Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
Cardiovasc Intervent Radiol. 2019 Dec;42(12):1760-1770. doi: 10.1007/s00270-019-02295-6. Epub 2019 Jul 30.
Evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) insertion on patients with schistosomiasis-induced liver fibrosis, and compare with that of patients with HBV-induced cirrhosis.
This was a retrospective study from November 2015 to December 2018 including 82 patients diagnosed with portal hypertension, one group of which is induced by schistosomiasis (n = 20), the other by hepatitis B virus (HBV) (n = 62). Both groups of subjects underwent TIPS placement for the management of portal hypertension complications.
TIPS was inserted successfully in all patients (technical success 100%). After a median follow-up of 14 months following TIPS insertion, portal pressure gradient (PPG) value in both schistosomiasis-induced group and HBV-induced group underwent a significant decrease with no major difference between the two groups. There exists no significant difference demonstrated by Kaplan-Meier curves between two groups concerning cumulative rate of hepatic encephalopathy (HE) (log-rank p = 0.681), variceal rebleeding (log-rank p = 0.837) and survival (log-rank p = 0.429), and no statistically difference was found in terms of alleviation of portal vein thrombosis (PVT). In addition, splenectomy (HR 19, 95% CI 4-90, p < 0.001) was identified as independent predictor of PVT.
TIPS placement is well-founded to be considered as a safe and effective treatment in patients with schistosomiasis-induced portal hypertension and relevant severe complications. We also found the risk of PVT is 19 times higher in patients who underwent splenectomy than in untreated patients.
Historically controlled studies, level 4.
评估经颈静脉肝内门体分流术（TIPS）治疗血吸虫病性肝纤维化患者的疗效和安全性，并与乙型肝炎病毒（HBV）相关性肝硬化患者进行比较。
这是一项回顾性研究，纳入了 2015 年 11 月至 2018 年 12 月期间诊断为门静脉高压的 82 例患者，其中一组由血吸虫病引起（n=20），另一组由乙型肝炎病毒引起（n=62）。两组患者均因门静脉高压并发症而行 TIPS 置入术。
所有患者均成功进行 TIPS 置入（技术成功率 100%）。TIPS 置入后中位随访 14 个月，血吸虫病组和 HBV 组的门静脉压力梯度（PPG）值均显著下降，但两组间无显著差异。两组患者的肝性脑病（HE）累积发生率（对数秩检验 p=0.681）、静脉曲张再出血（对数秩检验 p=0.837）和生存率（对数秩检验 p=0.429）的 Kaplan-Meier 曲线无显著差异，门静脉血栓形成（PVT）的缓解情况也无统计学差异。此外，脾切除术（HR 19，95%CI 4-90，p<0.001）是 PVT 的独立预测因素。
TIPS 置入术治疗血吸虫病性门静脉高压及其相关严重并发症安全有效。我们还发现，与未治疗的患者相比，行脾切除术的患者发生 PVT 的风险增加了 19 倍。
历史对照研究，4 级。
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