经颈静脉肝内门体分流术治疗PA-HSOS和失代偿期肝硬化相关顽固性腹水的生存预后分析

目的比较含吡咯里西啶植物诱发的肝窦阻塞综合征（PA-HSOS）和失代偿期肝硬化合并顽固性腹水行经颈静脉肝内门体分流术（TIPS）治疗病人的生存预后。方法回顾性分析141例PA-HSOS和42例失代偿期肝硬化并发顽固性腹水采用TIPS治疗的病人的临床资料，采用Kaplan-Meier分析计算2组病人TIPS术后生存率，并采用log-rank检验进行比较。并采用倾向性评分匹配（PSM），卡钳值设置为0.2，以1∶1匹配年龄、终末期肝病模型（MELD）评分、术前显性肝性脑病、术前门静脉系统血栓、门静脉血流速度。结果所有病人的中位随访时间为16.57个月。PA-HSOS病人的术前Child-Pugh分级和MELD评分均高于失代偿期肝硬化病人（P < 0.01），2组病人TIPS术后生存时间差异无统计学意义16.63（10.67~26.60）个月vs 16.47（9.40~41.53）个月]（P>0.05）。进行倾向性评分匹配后，24例PA-HSOS和24例失代偿期肝硬化病人成功匹配，PA-HSOS病人的术后生存时间长于失代偿期肝硬化病人15.17（10.27~27.03）个月vs 13.75（10.67~21.07）个月]（P < 0.01）。结论TIPS治疗PA-HSOS或失代偿期肝硬化相关顽固性腹水，尽管前者术前肝功能和门静脉血流动力学更差，但PA-HSOS病人术后生存不劣于失代偿期肝硬化病人。

Analysis of survival prognosis of the transjugular intrahepatic portosystemic shunt in the treatment of PA-HSOS and decompensated cirrhose-related refractory ascites

ObjectiveTo compare the survival prognosis of the transjugular intrahepatic portosystemic shunt(TIPS) in the treatment of pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome(PA-HSOS) and decompensated cirrhose-related refractory ascites.MethodsThe clinical data of 141 patients with PA-HSOS and 42 patients with decompensated cirrhose-related refractory ascites were retrospective analyzed.The survival rates in two groups after TIPS were calculated using the Kaplan-Meier analysis, and the results of which was compared using log-rank test.The propensity score matching(PSM) was used, the caliper value was set to 0.2.The age, end-stage model of liver disease(MELD) score, preoperative dominant hepatic encephalopathy, preoperative portal venous thrombosis and portal venous blood flow velocity were matched by 1:1.ResultsThe median survival time in all cases was 16.57 months.The preoperative Child-Pugh grade and MELD score in PA-HSOS patients were higher than those in decompensated cirrhosis patients(P < 0.01).There was no statistical significance in the survival time after TIPS between two groups16.63 (10.67-26.60) months vs 16.47 (9.40-41.53) months] (P>0.05).After propensity score matching, 24 cases with PA-HSOS were successfully matched with 24 cases with decompensated cirrhosis.The survival time of PA-HSOS patients was longer than that of decompensated cirrhosis patients15.17(10.27-27.03) months vs 13.75(10.67-21.07) months] (P < 0.01).ConclusionsThe TIPS can treat the PA-HSOS or decompensated cirrhose-related refractory ascites.Although the former has poorer preoperative liver function and portal hemodynamics, the PA-HSOS patients do not have worse postoperative survival compared with the decompensated cirrhose-related refractory ascites patients.