Huang Qianxin, Zhang Qingqiao, Xu Hao, Zu Maoheng, Xiao Jinchang, Shen Bin
Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Eur J Gastroenterol Hepatol. 2023 Apr 1;35(4):445-452. doi: 10.1097/MEG.0000000000002509. Epub 2023 Jan 5.
Anticoagulation therapy (AT) is often used as the initial treatment for pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS). However, transjugular intrahepatic portosystemic shunt (TIPS) is an alternative treatment. This study aimed to determine the mid- to long-term outcomes of TIPS versus AT as the initial treatment for PA-induced HSOS.
We retrospectively analyzed the clinical data of 61 patients with PA-induced HSOS that were collected between November 2015 and July 2021. The patients were allocated to the TIPS group ( n = 20) or the AT group ( n = 41). These two groups were divided into subgroups according to the severity grading. The clinical data of the patients in both groups were analyzed. Cumulative survival rates were calculated and compared between the two groups and among the subgroups.
The clinical symptoms and signs improved or stabilized in 100% of the patients following TIPS and in 85% of the patients following AT at discharge ( P = 0.166). The mortality rate was 0.0% in the TIPS group and 34.1% in the AT group ( P = 0.005). The patients were followed up for 2-69 months (mean, 26.3 ± 20.5 months). In the mild- and moderate-grade subgroups, there was no difference in the cumulative survival rate between the TIPS and AT groups ( P = 0.589 and P = 0.364, respectively). In the severe and very severe-grade subgroups, the cumulative survival rate was higher in the TIPS group than in the AT group ( P = 0.018 and P = 0.025, respectively).
AT is a suitable initial treatment for mild or moderate PA-induced HSOS, whereas TIPS should be considered the appropriate initial treatment for severe or very severe PA-induced HSOS.
抗凝治疗（AT）常被用作吡咯里西啶生物碱（PA）诱导的肝窦阻塞综合征（HSOS）的初始治疗方法。然而，经颈静脉肝内门体分流术（TIPS）是一种替代治疗方法。本研究旨在确定TIPS与AT作为PA诱导的HSOS初始治疗方法的中长期疗效。
我们回顾性分析了2015年11月至2021年7月期间收集的61例PA诱导的HSOS患者的临床资料。将患者分为TIPS组（n = 20）或AT组（n = 41）。这两组根据严重程度分级进一步分为亚组。分析两组患者的临床资料。计算并比较两组及各亚组的累积生存率。
TIPS治疗后100%的患者临床症状和体征改善或稳定，AT治疗后出院时85%的患者临床症状和体征改善或稳定（P = 0.166）。TIPS组死亡率为0.0%，AT组为34.1%（P = 0.005）。患者随访2 - 69个月（平均26.3±20.5个月）。在轻度和中度亚组中，TIPS组和AT组的累积生存率无差异（分别为P = 0.589和P = 0.364）。在重度和极重度亚组中，TIPS组的累积生存率高于AT组（分别为P = 0.018和P = 0.025）。
AT是轻度或中度PA诱导的HSOS的合适初始治疗方法，而TIPS应被视为重度或极重度PA诱导的HSOS的合适初始治疗方法。
