Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China; Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 312, Xihong Road, Fuzhou, Fujian 350025, China.
Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China.
Eur J Intern Med. 2023 Jun;112:77-85. doi: 10.1016/j.ejim.2023.03.024. Epub 2023 Mar 27.
Spontaneous portosystemic shunt (SPSS) other than esophago-gastric varices is one of the consequences of cirrhosis-induced portal hypertension (PHT), but its role is not fully understood. Therefore, we conducted a systematic review and meta-analysis to determine the prevalence and clinical characteristics of SPSS (excluding esophago-gastric varices) and its impact on mortality in patients with cirrhosis.
Eligible studies were identified from MedLine, PubMed, Embase, Web of Science, and Cochrane Library between Jan 1, 1980 and Sep 30, 2022. Outcome indicators were SPSS prevalence, liver function, decompensated events, and overall survival (OS).
Totally, 2015 studies were reviewed, of which 19 studies recruiting 6884 patients were included. On pooled analysis, the prevalence of SPSS was 34.2% (26.6%∼42.1%). SPSS patients had significantly higher Child-Pugh scores and grades and Model for End-stage Liver Disease scores (all P<0.05). Moreover, SPSS patients experienced a higher incidence of decompensated events, including hepatic encephalopathy, portal vein thrombosis, and hepatorenal syndrome (all P<0.05). Additionally, SPSS patients had significantly shorter OS than the non-SPSS group (P<0.05).
In patients with cirrhosis, SPSS outside the esophago-gastric region is common, characterized by severe impairment of liver function, high rates of decompensated events, including HE, PVT, and hepatorenal syndrome, as well as a high mortality rate.
除食管胃静脉曲张外，自发性门体分流（SPSS）是肝硬化引起的门静脉高压（PHT）的后果之一，但其作用尚未完全阐明。因此，我们进行了系统评价和荟萃分析，以确定肝硬化患者 SPSS（不包括食管胃静脉曲张）的患病率和临床特征及其对死亡率的影响。
我们在 1980 年 1 月 1 日至 2022 年 9 月 30 日期间从 MedLine、PubMed、Embase、Web of Science 和 Cochrane Library 中检索到符合条件的研究。结局指标为 SPSS 患病率、肝功能、失代偿事件和总生存率（OS）。
共评价了 2015 项研究，其中包括 19 项研究共纳入 6884 例患者。汇总分析显示，SPSS 的患病率为 34.2%（26.6%~42.1%）。SPSS 患者的 Child-Pugh 评分、分级和终末期肝病模型评分明显更高（均 P<0.05）。此外，SPSS 患者的失代偿事件发生率更高，包括肝性脑病、门静脉血栓形成和肝肾综合征（均 P<0.05）。此外，SPSS 患者的 OS 明显短于非 SPSS 组（P<0.05）。
在肝硬化患者中，食管胃区域以外的 SPSS 很常见，其特征为肝功能严重受损、失代偿事件发生率高，包括肝性脑病、门静脉血栓形成和肝肾综合征，死亡率也较高。
