食管静脉曲张作为肝性脑病患者经皮球囊闭塞逆行静脉栓塞术后致命结局的独立预测因素。
Esophageal Varices as an Independent Predictor of Fatal Outcomes after Balloon-Occluded Retrograde Transvenous Obliteration in Patients with Hepatic Encephalopathy.
作者信息
Iwasaki Shuichiro, Uojima Haruki, Sakita Shinya, Masuda Sakue, Kubota Kousuke, Fujikawa Tomoaki, Okubo Tomomi, Setsu Toru, Itokawa Norio, Furuichi Yoshihiro, Arase Yoshitaka, Tukiyama Toshiki, Fujii Kaoru, Hidaka Hisashi, Atsukawa Masanori, Kagawa Tatehiro, Kako Makoto, Terai Shuji, Kusano Chika
机构信息
Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan.
出版信息
Dig Dis. 2024;42(6):583-592. doi: 10.1159/000541660. Epub 2024 Sep 30.
INTRODUCTION
The objective of this study was to evaluate esophageal varices (EVs) as predictors of poor prognosis with low tolerability after balloon-occluded retrograde transvenous obliteration (BRTO) in patients with overt hepatic encephalopathy (HE).
METHODS
This study retrospectively enrolled 107 patients who underwent BRTO for uncontrollable overt HE. The enrolled patients were divided into two groups based on the presence of EVs using propensity matching. The present study assessed the technical success rate and safety of BRTO in both the groups. Further, the event-free survival, HE-free survival, and the overall survival (OS) were compared between the two groups. Event-free survival was defined as the time period during which the patients did not developed complications related to portal hypertension, including EVs, hepatic ascites, and portal vein thrombosis.
RESULTS
After propensity matching, the EV and non-EV groups had 37 and 36 patients, respectively. Only 1 patient experienced an unsuccessful procedure in the EV group. Procedure-related adverse events in the EV group and non-EV group occurred in 11 and 7 patients, respectively (p = 0.417). The event-free survival after BRTO in the EV and non-EV group were 1,283 (95% CI: 798-1,767) days and 2,257 (1,722-2,792) days, respectively. Event-free survival was significantly worse in the EV group than in the non-EV group (p = 0.014). Furthermore, the EV group experienced worse OS than the non-EV group (p = 0.001 and p < 0.001, respectively).
CONCLUSIONS
The presence of EVs could potentially be associated with a higher risk of adverse outcomes or mortality after BRTO treatment in individuals with HE.
引言
本研究的目的是评估食管静脉曲张（EVs）作为显性肝性脑病（HE）患者经球囊闭塞逆行静脉栓塞术（BRTO）后预后不良和耐受性低的预测指标。
方法
本研究回顾性纳入了107例因无法控制的显性HE而接受BRTO的患者。根据EVs的存在情况，采用倾向匹配法将纳入的患者分为两组。本研究评估了两组BRTO的技术成功率和安全性。此外，比较了两组的无事件生存期、无HE生存期和总生存期（OS）。无事件生存期定义为患者未发生与门静脉高压相关并发症的时间段，包括EVs、肝腹水和门静脉血栓形成。
结果
倾向匹配后，EV组和非EV组分别有37例和36例患者。EV组仅1例手术未成功。EV组和非EV组分别有11例和7例患者发生与手术相关的不良事件（p = 0.417）。BRTO术后，EV组和非EV组的无事件生存期分别为1283天（95%CI：798 - 1767）和2257天（1722 - 2792）。EV组的无事件生存期明显低于非EV组（p = 0.014）。此外，EV组的OS也比非EV组差（分别为p = 0.001和p < 0.001）。
结论
EVs的存在可能与HE患者BRTO治疗后不良结局或死亡风险较高有关。
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