Xia Yifu, Tie Jun, Wang Guangchuan, Wu Hao, Zhuge Yuzheng, Yuan Xulong, Huang Guangjun, Li Zhen, Zhang Linhao, Cai Zihao, Tang Chengwei, Zhang Chunqing
Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Hepatol Int. 2025 Feb;19(1):199-211. doi: 10.1007/s12072-024-10742-x. Epub 2024 Nov 9.
Transjugular intrahepatic portosystemic shunt (TIPS) is recommended for treating recurrent and refractory ascites. However, determining the target portal pressure gradient (PPG) has been inconclusive. This multicentre cohort study explored the post-TIPS PPG potential range associated with improving survival.
The study enrolled 276 patients, all of whom underwent covered TIPS for ascites treatment across four medical centers. The cumulative incidences of clinical outcomes were compared among groups categorized by potential PPG thresholds.
During the whole follow-up period with a medium follow-up of 21.6 (7.5, 41.6) months, 122 (44.2%) experienced liver-related death, and 73 (26.4%) patients experienced a recurrence of ascites. Multivariable analysis revealed PPG < 7 mmHg (p = 0.007) and the recurrence of ascites (p = 0.033) are independent risk factors for survival, while the PPG ≥ 11 mmHg was an independent risk factor for the recurrence of ascites (p = 0.012). Patients with ≥ 7 mmHg had a lower rate of liver-related death than patients with post-TIPS PPG < 7 mmHg (51.0% vs 66.6%, p = 0.004), while those with post-TIPS PPG ≥ 11 mmHg exhibited a higher cumulative incidence of ascites compared to those with post-TIPS PPG < 11 mmHg (44.6% vs 33.7%, p = 0.023). The robustness of the results was confirmed.
Our study highlighted the existence of an optimal post-TIPS PPG range in patients with recurrent and refractory ascites. Patients may experience improved survival and ascites control with a post-TIPS PPG of 7-11 mmHg.
经颈静脉肝内门体分流术（TIPS）被推荐用于治疗复发性和难治性腹水。然而，确定目标门静脉压力梯度（PPG）尚无定论。这项多中心队列研究探讨了与改善生存率相关的TIPS术后PPG潜在范围。
该研究纳入了276例患者，所有患者均在四个医疗中心接受了覆膜TIPS治疗腹水。比较按潜在PPG阈值分类的各组临床结局的累积发生率。
在中位随访时间为21.6（7.5，41.6）个月的整个随访期间，122例（44.2%）患者发生肝脏相关死亡，73例（26.4%）患者腹水复发。多变量分析显示，PPG＜7 mmHg（p = 0.007）和腹水复发（p = 0.033）是生存的独立危险因素，而PPG≥11 mmHg是腹水复发的独立危险因素（p = 0.012）。TIPS术后PPG≥7 mmHg的患者肝脏相关死亡率低于TIPS术后PPG＜7 mmHg的患者（51.0%对66.6%，p = 0.004），而TIPS术后PPG≥11 mmHg的患者与TIPS术后PPG＜11 mmHg的患者相比，腹水累积发生率更高（44.6%对33.7%，p = 0.023）。结果的稳健性得到了证实。
我们的研究强调了复发性和难治性腹水患者存在最佳的TIPS术后PPG范围。TIPS术后PPG为7 - 11 mmHg的患者可能生存率提高且腹水得到控制。
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