不同病因肝硬化患者经颈静脉肝内门体分流术临床疗效

Clinical Effect of Intrahepatic Portal Shunt through Jugular Vein in Patients with Cirrhosis of Different Etiology

摘要: 目的：探讨不同病因引起的肝硬化患者经颈静脉肝内门体分流术(Transjugular Intrahepatic Portasystemic Shunt, TIPS)治疗的预后差异的临床意义。方法：回顾性分析2016年10月~2021年10月我院的肝硬化患者的临床资料，根据肝硬化病因分为病毒性肝炎组与非病毒性肝炎组。比较两组患者性别、年龄、合并症、手术病因、术后6个月生存情况差异，比较分析两组患者肝功能储备变化及预后，比较TIPS术前术后指标变化。组间计量资料用t检验，非正态分布采用秩和检验，术前术后比较采用配对t检验，计数资料卡方检验进行比较。结果：两组患者年龄、手术病因、合并症(冠心病、糖尿病、感染、肝性脑病)方面、术后6个月生存率、肝功能分级(Child、MELD评分、FIPS评分)比较差异无统计学意义(P > 0.05)，性别构成、合并肝癌差异有统计学意义(P < 0.05)。两组患者在术前术后门静脉值、白蛋白(albumin, ALB)、胆红素(total bilirubin, TBIL)、谷草转氨酶(aspartate aminotransferase, AST)、凝血功能(D-二聚体(D-Dimer)，凝血酶原时间(prothrombin time, PT)、活化部分凝血酶原时间(activated partial prothrombin time, APTT))比较差异无统计学意义(P > 0.05)，在术前术后血小板(platelets, PLT)、术后谷丙转氨酶(glutamate pyruvate transaminase, ALT)方面比较差异有统计学意义(P < 0.05)。两组患者术后均出现TBIL、AST、ALT、D-Dimer升高，PT、APTT延长(P < 0.05)。结论：病毒性肝硬化患者血小板更低，病毒性肝硬化患者在接受TIPS治疗后更容易发生短期内肝功能改变。

Abstract: Objective: To explore the clinical significance of prognostic differences in transjugular intrahepatic portasystemic shunt (TIPS) treatment in patients with cirrhosis caused by different etiologies. Methods: The clinical data of patients with liver cirrhosis hospitalized from October 2016 to October 2021 were retrospectively analyzed, and liver cirrhosis was divided into viral hepatitis group and non-viral hepatitis group according to the etiology. The differences in gender, age, comorbidities, surgical etiology, and 6-month postoperative survival were compared between the two groups. The changes in liver function reserve and prognosis were compared between the two groups. The changes in TIPS indicators before and after TIPS were compared. The t-test was used for measure-ment data between groups, the rank sum test was used for non-normal distribution, the paired t-test was used for preoperative and postoperative comparisons, and the chi-square test was used for enumeration data. Results: There was no significant difference in age, surgical etiology, compli-cations (coronary heart disease, diabetes, infection, hepatic encephalopathy), postoperative 6-month survival rate, and liver function classification (Child, MELD score, FIPS score) between the two groups Significant (P > 0.05), there were statistically significant differences in gender composi-tion and incidence of liver cancer (P < 0.05). There was no significant difference in portal vein value, albumin, bilirubin, aspartate aminotransferase, coagulation function (D-dimer, prothrombin time, activated partial prothrombin time) between the two groups before and after operation (P > 0.05), there were statistically significant differences in platelets and alanine aminotransferase before and after surgery (P < 0.05). Bilirubin, alanine aminotransferase, aspartate aminotransferase, and D-dimer were elevated, and prothrombin time and activated partial prothrombin time were pro-longed in both groups after operation (P < 0.05). Conclusion: Patients with viral cirrhosis have lower platelets and are more prone to liver cancer. Patients with viral cirrhosis are more likely to experi-ence short-term changes in liver function after receiving TIPS treatment.