脾脏硬度预测肝硬化患者经颈静脉肝内门体分流术后的生存情况。

Spleen Stiffness Predicts Survival after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients.

机构信息

Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.

Department of Gastroenterology, Affiliated Drum Tower Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu, China.

出版信息

Biomed Res Int. 2020 Nov 13;2020:3860390. doi: 10.1155/2020/3860390. eCollection 2020.

DOI:10.1155/2020/3860390

PMID:33282945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7685811/

Abstract

OBJECTIVES

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications. Little is known about the ability of spleen stiffness (SS) for predicting the survival of cirrhotic patients undergoing TIPS. This study is to evaluate the influence of SS detected by point shear wave elastography (pSWE) in predicting survival after TIPS.

METHODS

This retrospective cohort study screened consecutive patients who underwent TIPS and reliable pSWE measurement between October 2014 and September 2017 from our prospectively maintained database. SS values were measured before TIPS. The primary endpoint was the overall survival after TIPS. The Cox regression analysis model was used for univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and positive and negative predictive values.

RESULTS

A total of 89 patients were involved in the final analysis. 24 patients (27.0%) died during a median follow-up time of 31 m. Multivariable Cox regression analysis confirmed that higher SS value ( < 0.001), LS value ( = 0.008), diameter of shunt ( = 0.001), and older age ( < 0.001) were independent prognostic factors of survival after TIPS. The risk of death rose 57.440-fold for each SS unit (m/s) increase. SS was also correlated with liver failure after TIPS. ROC analysis showed that the best SS cutoff value was 3.60 m/s for predicting survival, with a sensitivity of 54.2% and specificity of 90.8%.

CONCLUSIONS

The SS value determined by pSWE in cirrhotic patients was an independent predictive factor for survival after TIPS.

摘要

目的

经颈静脉肝内门体分流术（TIPS）是治疗门脉高压并发症的有效方法。脾硬度（SS）预测 TIPS 术后肝硬化患者生存的能力知之甚少。本研究旨在评估实时剪切波弹性成像（pSWE）检测的 SS 对 TIPS 后生存的预测影响。

方法

本回顾性队列研究从我们前瞻性维护的数据库中筛选了 2014 年 10 月至 2017 年 9 月期间连续接受 TIPS 和可靠 pSWE 测量的患者。在 TIPS 前测量 SS 值。主要终点是 TIPS 后的总生存率。采用 Cox 回归分析模型进行单因素和多因素分析。绘制受试者工作特征（ROC）曲线分析以计算灵敏度、特异性、阳性和阴性预测值。

结果

共有 89 例患者最终纳入分析。中位随访时间为 31 个月时，24 例（27.0%）患者死亡。多因素 Cox 回归分析证实，较高的 SS 值（<0.001）、LS 值（=0.008）、分流直径（=0.001）和年龄较大（<0.001）是 TIPS 后生存的独立预后因素。SS 每增加 1 个单位（m/s），死亡风险增加 57.440 倍。SS 还与 TIPS 后肝功能衰竭相关。ROC 分析显示，预测生存的最佳 SS 截断值为 3.60 m/s，灵敏度为 54.2%，特异性为 90.8%。