TIPSS for variceal bleeding in patients with idiopathic non-cirrhotic portal hypertension: comparison with patients who have cirrhosis

被引：34

作者：

Lv, Yong ^{[1
,2
]}

Li, Kai ^{[1
,2
]}

He, Chuangye ^{[1
,2
]}

Luo, Bohan ^{[1
,2
]}

Zhang, Bojing ^{[1
,2
]}

Liu, Haibo ^{[1
,2
]}

Wang, Zhengyu ^{[1
,2
]}

Guo, Wengang ^{[1
,2
]}

Wang, Qiuhe ^{[1
,2
]}

Chen, Hui ^{[1
,2
]}

Bai, Wei ^{[1
,2
]}

Yuan, Xulong ^{[1
,2
]}

Yu, Tianlei ^{[1
,2
]}

Li, Xiaomei ^{[1
,2
]}

Yuan, Jie ^{[1
,2
]}

Han, Na ^{[1
,2
]}

Zhu, Ying ^{[1
,2
]}

Niu, Jing ^{[1
,2
]}

Xie, Huahong ^{[2
,3
]}

Wang, Jianhong ^{[2
,4
]}

Chen, Ling ^{[5
]}

Yin, Zhanxin ^{[1
,2
]}

Fan, Daiming ^{[2
,6
]}

Li, Zengshan ^{[5
]}

Han, Guohong ^{[1
,2
]}

机构：

[1] Fourth Mil Med Univ, Dept Liver Dis & Digest Intervent Radiol, Natl Clin Res Ctr Digest Dis, Xian, Shaanxi, Peoples R China

[2] Fourth Mil Med Univ, Xijing Hosp Digest Dis, Xian, Shaanxi, Peoples R China

[3] Fourth Mil Med Univ, Dept Digest Endoscopy, Natl Clin Res Ctr Digest Dis, Xian, Shaanxi, Peoples R China

[4] Fourth Mil Med Univ, Dept Ultrasound, Natl Clin Res Ctr Digest Dis, Xian, Shaanxi, Peoples R China

[5] Fourth Mil Med Univ, Dept Pathol, Xijing Hosp, Xian, Shaanxi, Peoples R China

[6] Fourth Mil Med Univ, Natl Clin Res Ctr Digest Dis, State Key Lab Canc Biol, Xian, Shaanxi, Peoples R China

来源：

ALIMENTARY PHARMACOLOGY & THERAPEUTICS | 2019年 / 49卷 / 07期

基金：

中国国家自然科学基金;

关键词：

INTRAHEPATIC PORTOSYSTEMIC SHUNT; METHYLENETETRAHYDROFOLATE REDUCTASE C677T; BUDD-CHIARI-SYNDROME; VEIN THROMBOSIS; HEPATIC-ENCEPHALOPATHY; NATURAL-HISTORY; CONSENSUS WORKSHOP; ASSOCIATION; DIAGNOSIS; SURVIVAL;

D O I：

10.1111/apt.15186

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background In patients with idiopathic non-cirrhotic portal hypertension (INCPH), the usual recommended strategy for management of variceal bleeding is the same as that in cirrhosis. However, this policy has been challenged by the different natural history between INCPH and cirrhosis. Aim To compare outcomes after transjugular intrahepatic portosystemic shunt (TIPSS) between INCPH and cirrhotic patients admitted for variceal bleeding. Methods Between March 2001 and September 2015, 76 consecutive patients with biopsy-proven INCPH undergoing TIPSS for variceal bleeding in a tertiary-care centre were included. 76 patients with cirrhotic portal hypertension receiving TIPSS for variceal bleeding, and matched for age, sex, Child-Pugh class, stent type and index year of TIPSS creation served as controls. Results Patients with INCPH, compared to those with cirrhosis, had significantly lower mortality (11% vs 36% at 5 years, adjusted HR, 0.37; 95% CI 0.15-0.87, P = 0.022), overt hepatic encephalopathy (16% vs 33% at 5 years, adjusted HR, 0.35; 95% CI 0.16-0.75, P = 0.007) and hepatic impairment, despite similar rates of further bleeding (33% vs 32% at 5 years, adjusted HR, 0.72; 95% CI 0.36-1.44, P = 0.358), and shunt dysfunction (35% vs 36% at 5 years, adjusted HR, 0.84; 95% CI 0.41-1.72, P = 0.627). These findings were consistent across different relevant subgroups. Conclusions Patients with INCPH treated with TIPSS for variceal bleeding had similar progression of portal hypertension (further bleeding and shunt dysfunction) but fewer complications of liver disease (overt hepatic encephalopathy and hepatic insufficiency) and lower mortality rate compared with cirrhotic patients with comparable liver function.

引用

页码：926 / 939

页数：14

共 50 条

[1]

Amer Assoc Study Liver Dis, 2014, J HEPATOL, V61, P642, DOI 10.1016/j.jhep.2014.05.042

[2] Role of the Transjugular Intrahepatic Portosystemic Shunt in the Management of Severe Complications of Portal Hypertension in Idiopathic Noncirrhotic Portal Hypertension [J].