Vidal-González Judit, Martínez Javier, Mulay Akhilesh, López Marta, Baiges Anna, Elmahdy Ahmed, Lampichler Katharina, Maleux Geert, Chang Johannes, Poncela Marta, Low Gavin, Ghigliazza Gabriele, Zipprich Alexander, Picón Carmen, Shah Rushabh, Llop Elba, Darnell Anna, Maurer Martin H, Bonne Lawrence, Ramón Enrique, Quiroga Sergi, Abraldes Juan G, Krag Aleksander, Trebicka Jonel, Ripoll Cristina, La Mura Vincenzo, Tandon Puneeta, García-Martínez Rita, Praktiknjo Michael, Laleman Wim, Reiberger Thomas, Berzigotti Annalisa, Hernández-Gea Virginia, Calleja José Luis, Tsochatzis Emmanuel A, Albillos Agustín, Simón-Talero Macarena, Genescà Joan
Liver Unit, Digestive Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus. Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain.
JHEP Rep. 2023 Nov 30;6(2):100977. doi: 10.1016/j.jhepr.2023.100977. eCollection 2024 Feb.
BACKGROUND & AIMS: Spontaneous portosystemic shunts (SPSS) develop frequently in cirrhosis. Changes over time and the effect of aetiological interventions on SPSS are unknown, so we aimed to explore the effect of these variables on SPSS evolution.
Patients with cirrhosis from the Baveno VI-SPSS cohort were selected provided a follow-up abdominal CT or MRI scan was available. Clinical and laboratory data were collected at baseline and follow-up. Imaging tests were reviewed to evaluate changes in the presence and size of SPSS (large (L)-SPSS was ≥8 mm) over time. Regarding alcohol- or HCV-related cirrhosis, two populations were defined: cured patients (abstinent from alcohol or successful HCV therapy), and non-cured patients.
A total of 617 patients were included. At baseline SPSS distribution was 22% L-SPSS, 30% small (S)-SPSS, and 48% without (W)-SPSS. During follow-up (median follow-up of 63 months), SPSS distribution worsened: L-SPSS 26%, S-SPSS 32%, and W-SPSS 42% ( <0.001). Patients with worse liver function during follow-up showed a simultaneous aggravation in SPSS distribution. Non-cured patients (n = 191) experienced a significant worsening in liver function, more episodes of liver decompensation and lower transplant-free survival compared to cured patients (n = 191). However, no differences were observed regarding SPSS distribution at inclusion and at follow-up, with both groups showing a trend to worsening. Total shunt diameter increased more in non-cured (52%) than in cured patients (28%). However, total shunt area (TSA) significantly increased only in non-cured patients (74 to 122 mm, <0.001).
The presence of SPSS in cirrhosis increases over time and parallels liver function deterioration. Aetiological intervention in these patients reduces liver-related complications, but SPSS persist although progression is decreased.
There is no information regarding the evolution of spontaneous portosystemic shunts (SPSS) during the course of cirrhosis, and especially after disease regression with aetiological interventions, such as HCV treatment with direct-acting antivirals or alcohol abstinence. These results are relevant for clinicians dealing with patients with cirrhosis and portal hypertension because they have important implications for the management of cirrhosis with SPSS after disease regression. From a practical point of view, physicians should be aware that in advanced cirrhosis with portal hypertension, after aetiological intervention, SPSS mostly persist despite liver function improvement, and complications related to SPSS may still develop.
自发性门体分流（SPSS）在肝硬化患者中很常见。其随时间的变化以及病因学干预对SPSS的影响尚不清楚，因此我们旨在探讨这些变量对SPSS演变的影响。
选取巴韦诺VI-SPSS队列中的肝硬化患者，条件是有随访腹部CT或MRI扫描结果。在基线和随访时收集临床和实验室数据。回顾影像学检查以评估SPSS（大（L）-SPSS≥8mm）的存在情况和大小随时间的变化。对于酒精性或丙型肝炎病毒（HCV）相关肝硬化，定义了两个人群：治愈患者（戒酒或HCV治疗成功）和未治愈患者。
共纳入617例患者。基线时SPSS分布为22%大分流（L-SPSS）、30%小分流（S-SPSS）和48%无分流（W-SPSS）。随访期间（中位随访63个月），SPSS分布恶化：L-SPSS为26%，S-SPSS为32%，W-SPSS为42%（P<0.001）。随访期间肝功能较差的患者SPSS分布同时加重。与治愈患者（n=191）相比，未治愈患者（n=191）肝功能显著恶化，肝失代偿发作更多，无移植生存期更短。然而，纳入时和随访时SPSS分布无差异，两组均有恶化趋势。未治愈患者的总分流直径增加更多（52%），而治愈患者为28%。然而，仅未治愈患者的总分流面积（TSA）显著增加（从74mm²至122mm²，P<0.001）。
肝硬化患者中SPSS的发生率随时间增加，且与肝功能恶化平行。对这些患者进行病因学干预可减少肝脏相关并发症，但SPSS仍然存在，尽管进展有所减缓。
关于肝硬化病程中，尤其是病因学干预（如使用直接抗病毒药物治疗HCV或戒酒）使疾病消退后，自发性门体分流（SPSS）的演变情况尚无相关信息。这些结果对处理肝硬化和门静脉高压患者的临床医生具有重要意义，因为它们对疾病消退后伴有SPSS的肝硬化管理具有重要影响。从实际角度来看，医生应意识到，在晚期肝硬化伴门静脉高压患者中，病因学干预后，尽管肝功能有所改善，但SPSS大多仍然存在，且与SPSS相关的并发症仍可能发生。
