TIPS术后短期总胆红素显著升高的相关因素分析及其对生存预后的影响

目的：探讨经颈静脉肝内门腔静脉分流术（TIPS）后短期总胆红素显著升高的相关因素，观察术后短期总胆红素显著升高对患者长期生存预后的影响。 方法：选取2009年1月—2015年12月我院收治的因肝硬化门静脉高压失代偿接受TIPS治疗的患者202例。根据术后短期内是否出现总胆红素显著升高分为两组：A组为总胆红素未显著升高组106例，B组为总胆红素显著升高组96例。采用单因素分析及多元非条件Logistic回归模型分析TIPS术后短期总胆红素显著升高的相关影响因素，并通过长期随访对比分析两组患者术后的生存预后。 结果：202例患者均成功建立肝内门腔支架分流道。门静脉压力从术前的（24.2±5.1）mmHg降至（14.6±4.3）mmHg，差异有统计学意义（t=17.33，P<0.01）。TIPS术前总胆红素为（23.27±18.67）μmol/L，术后2周升至（36.52±28.17）μmol/L，差异有统计学意义（t=6.461，P <0.01）。单因素分析显示B组患者的年龄、术前总胆红素、术前Child-Pugh评分、肝内支架分流道长度均高于A组（P<0.05）；两组的门静脉高压病因、门静脉穿刺位置、术后门静脉分支显影情况以及分流道支架类型比较差异也均有统计学意义。多元非条件Logistics回归分析显示术前总胆红素、术前Child-Pugh评分、肝内支架分流道长度及术后门静脉分支显影情况与术后短期内总胆红素显著升高有关。Kaplan-Meier分析显示TIPS术后A组的生存率高于B组，有统计学差异（χ²=4.528，P=0.033），术后两组的分流道累积通畅率及HE发生率无统计学差异。 结论：术前总胆红素水平高、术前Child-Pugh评分高、肝内支架分流道长度长是TIPS术后短期总胆红素显著升高的危险因素，术后门静脉分支显影支数多是TIPS术后短期总胆红素显著升高的保护因素。术后短期总胆红素显著升高比未显著升高患者的长期累积生存率低。

Relevant factors analysis on significant increase of total bilirubin in short term after TIPS and its influence on survival prognosis

Objective:To investigate the relevant factors of significant increase of total bilirubin in short term after transjugular intrahepatic portosystemic shut (TIPS) and the influence of survival prognosis. Methods:A retrospective review including 202 patients with cirrhotic portal hypertension undergoing TIPS from January 2009 to December 2015 was performed. All patients were divided into two groups: without significant increase of total bilirubin in short term (group A, n=106) and significant increase of total bilirubin in short term (group B, n=96) after TIPS. The relative factors affecting significant increase of total bilirubin in short term after TIPS were analyzed by single factor analysis and multivariate non conditional Logistics regression model, and the survival prognosis of the two groups were analyzed by long-term follow-up. Results:The intrahepatic shunts were established successfully in all patients. The preoperative portal venous pressure was (24.2±5.1) mmHg, while postoperative portal venous pressure was (14.6±4.3) mmHg, with statistical difference (t=17.33, P<0.01) . The preoperative total bilirubin was (23.27±18.67) μmol/L, while total bilirubin was (36.52±28.17) μmol/L two weeks after TIPS, with statistical difference (t=6.461, P<0.01) . Single variate analysis showed that age, preoperative total bilirubin, preoperative Child-Pugh score and length of intrahepatic stent in group B were all higher than those of group A (P<0.05) , and there were statistical differences in pathogenesis of portal hypertension, puncture sites of portal vein, postoperative development of portal branch and type of stent between two groups (P<0.05) . Multivariate logistic regression model showed that the sign of significant increase of total bilirubin in short term after TIPS related to preoperative total bilirubin, preoperative Child-Pugh score, length of intrahepatic stent and postoperative development of portal branch. Kaplan-Meier analysis showed that group A had higher survival rate than group B (χ²=4.528, P=0.033) , and there was no significant difference between two groups in shunt patency and HE. Conclusions:Preoperative higher total bilirubin, preoperative higher Child-Pugh score and longer intrahepatic stent are the independent risk factors for significant increase of total bilirubin in short term after TIPS, while postoperative more development of portal branch is the independent protective factor. Significant increase of total bilirubin in short term after TIPS might have lower survival rate.