经颈静脉肝内门体分流术治疗肝硬化门静脉高压症的预后评估
|
摘要
经颈静脉肝内门体分流术(TIPS)是肝硬化门静脉高压症的一项重要治疗手段,但术后肝衰竭、肝性脑病等并发症一定程度限制了TIPS的临床应用。总结了血清学指标、临床指标、评分系统等TIPS术后预后评估的研究进展及临床价值。临床可根据实际情况选择不同指标或进行综合评估,以提高患者的术后生存率。
Transjugular intrahepatic portosystemic shunt( TIPS) is an important method for the treatment of cirrhotic portal hypertension;however,its clinical application is limited by postoperative complications such as liver failure and hepatic encephalopathy. This article summarizes and analyzes the research advances in the clinical value of serological markers,clinical indices,and scoring systems in prognostic evaluation of TIPS. Indices can be selected or comprehensive evaluation can be performed based on clinical situations,in order to improve patients' postoperative survival rate.
Transjugular intrahepatic portosystemic shunt( TIPS) is an important method for the treatment of cirrhotic portal hypertension;however,its clinical application is limited by postoperative complications such as liver failure and hepatic encephalopathy. This article summarizes and analyzes the research advances in the clinical value of serological markers,clinical indices,and scoring systems in prognostic evaluation of TIPS. Indices can be selected or comprehensive evaluation can be performed based on clinical situations,in order to improve patients' postoperative survival rate.
引文
[1]ROSSLE M,RICHTER GM,NOLDGE G,et al.New non-operative treatment for variceal hemorrhage[J].Lancet,1989,2(8655):153.
[2]DING ZF,YIN SW.Application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2018,34(5):1107-1110.(in Chinese)丁智锋,殷世武.Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状[J].临床肝胆病杂志,2018,34(5):1107-1110.
[3]CHEN SL,HU P,LIN ZP,et al.Relevant factors analysis on significant increase of total bilirubin in short term after TIPS and its influence on survival prognosis[J].Chin J Inter Rad:Electronic Edition,2018,6(1):40-45.(in Chinese)陈斯良,胡朋,林志鹏,等.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[J].中华介入放射学电子杂志,2018,6(1):40-45.
[4]YOON CJ,CHUNG JW,PARK JH.Transjugular intrahepatic portosystemic shunt for acute variceal bleeding in patients with viral liver cirrhosis:Predictors of early mortality[J].AJR Am JRoentgenol,2005,185(4):885-889.
[5]BUREAU C,MTIVIER S,D'AMICO M,et al.Serum bilirubin and platelet count:A simple predictive model for survival in patients with refractory ascites treated by TIPS[J].J Hepatol,2011,54(5):901-907.
[6]QI X,HE C,GUO W,et al.Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis:Outcomes and predictors in a prospective cohort study[J].Liver Int,2016,36(5):667-676.
[7]WANG LZ,LI X,SONG J,et al.Predictive factors for improved ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites[J].J Pract Radiol,2015,31(5):777-781.(in Chinese)王黎洲,李兴,宋杰,等.肝硬化合并顽固性腹水患者TIPS术后腹水改善的相关因素分析[J].实用放射学杂志,2015,31(5):777-781.
[8]JU W,ZHANG BJ,HAN GH.Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors[J].J Clin Hepatol,2016,32(8):1529-1533.(in Chinese)巨伟,张博静,韩国宏.经颈静脉肝内门体分流术治疗肝硬化顽固性腹水的长期效果及预后因素分析[J].临床肝胆病杂志,2016,32(8):1529-1533.
[9]NEGISHI M,WONGPALEE SP,SARKAR S,et al.A new lncRNA,APTR,associates with and represses the CDKN1A/p21 promoter by recruiting polycomb proteins[J].PLo S One,2014,9(4):e95216.
[10]YU F,ZHENG J,MAO Y,et al.Long non-coding RNA APTRpromotes the activation of hepatic stellate cells and the progression of liver fibrosis[J].Biochem Biophys Res Commun,2015,463(4):679-685.
[11]YU S,QI Y,JIANG J,et al.APTR is a prognostic marker in cirrhotic patients with portal hypertension during TIPS procedure[J].Gene,2018,645:30-33.
[12]TACKE F,ZIMMERMANN HW,BERRES ML,et al.Serum chemokine receptor CXCR3 ligands are associated with progression,organ dysfunction and complications of chronic liver diseases[J].Liver Int,2011,31(6):840-849.
[13]BERRES ML,ASMACHER S,LEHMANN J,et al.CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt[J].J Hepatol,2015,62(2):332-339.
[14]BERRES ML,LEHMANN J,JANSEN C,et al.Chemokine(C-X-C motif)ligand 11 levels predict survival in cirrhotic patients with transjugular intrahepatic portosystemic shunt[J].Liver Int,2016,36(3):386-394.
[15]JANSEN C,EISCHEID H,GOERTZEN J,et al.The role of miRNA-34a as a prognostic biomarker for cirrhotic patients with portal hypertension receiving TIPS[J].PLo S One,2014,9(7):e103779
[16]PUGH RN,MURRAY-LYON IM,DAWSON JL,et al.Transection of the oesophagus for bleeding oesophageal varices[J].Br J Surg,1973,60(8):646-649.
[17]CHEN H,BAI M,QI X,et al.Child-Na score:A predictive model for survival in cirrhotic patients with symptomatic portal hypertension treated with TIPS[J].PLo S One,2013,8(11):e79637
[18]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33(2):464-470.
[19]WANG HQ,LIN Y,YAN Y.Clinical study on the significcance of hyponatremia in patients with cirrhotic ascites[J].J Clin Exp Med,2017,16(22):2275-2278.(in Chinese)王慧卿,林叶,严艳.肝硬化腹水合并低钠血症的临床研究[J].临床和实验医学杂志,2017,16(22):2275-2278.
[20]GABA RC,COUTURE PM,BUI JT,et al.Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation[J].J Vasc Interv Radiol,2013,24(3):411-420.
[21]ZHOU C,HOU C,CHENG D,et al.Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement:A systematic metaanalytic review[J].Int J Clin Exp Med,2015,8(8):13464-13472.
[22]PENG Y,QI X,GUO X.Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis:A systematic review and meta-analysis of observational studies[J].Medicine(Baltimore),2016,95(8):e2877.
[23]PROCOPE B,TANTAU M,BUREAU C.Are there any alternative methods to hepatic venous pressure gradient in portal hypertension assessment?[J].J Gastrointestin Liver Dis,2013,22(1):73-78.
[24]XU ZG,ZHAO YB,ZHENG YY,et al.Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis[J].J Clin Hepatol,2016,32(12):2326-2330.(in Chinese)徐征国,赵泳冰,郑媛钰,等.肝硬化患者经颈静脉肝内门体分流术后门静脉压力下降梯度与预后的关系[J].临床肝胆病杂志,2016,32(12):2326-2330.
[25]ASCHA M,ABUQAYYAS S,HANOUNEH I,et al.Predictors of mortality after transjugular portosystemic shunt[J].World JHepatol,2016,8(11):520-529.
[26]QI X,GUO W,HE C,et al.Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome:Techniques,indications and results on 51 Chinese patients from a single centre[J].Liver Int,2014,34(8):1164-1175.
[27]DELTENRE P,TRPO E,RUDLER M,et al.Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding:A systematic review and meta-analysis of controlled trials[J].Eur J Gastroenterol Hepatol,2015,27(9):e1-e9.
[28]RUDLER M,CLUZEL P,CORVEC TL,et al.Early-TIPSSplacement prevents rebleeding in high-risk patients with variceal bleeding,without improving survival[J].Aliment Pharmacol Ther,2014,40(9):1074-1080.
[29]PARVINIAN A,SHAH KD,COUTURE PM,et al.Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk[J].J Vasc Interv Radiol,2013,24(7):941-946.
[30]LI Y,WANG F,CHEN X,et al.Short outcome comparison of elderly patients versus nonelderly patients treated with transjugular intrahepatic portosystemic stent shunt:A propensity score matched cohort study[J].Medicine(Baltimore),2017,96(29):e7551.
[31]SURAWEERA D,JIMENEZ M,VIRAMONTES M,et al.Agerelated morbidity and mortality after transjugular intrahepatic portosystemic shunts[J].J Clin Gastroenterol,2017,51(4):360-363.
[32]NARDELLI S,LATTANZI B,TORRISI S,et al.Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J].Clin Gastroenterol Hepatol,2017,15(6):934-936.
[2]DING ZF,YIN SW.Application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2018,34(5):1107-1110.(in Chinese)丁智锋,殷世武.Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状[J].临床肝胆病杂志,2018,34(5):1107-1110.
[3]CHEN SL,HU P,LIN ZP,et al.Relevant factors analysis on significant increase of total bilirubin in short term after TIPS and its influence on survival prognosis[J].Chin J Inter Rad:Electronic Edition,2018,6(1):40-45.(in Chinese)陈斯良,胡朋,林志鹏,等.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[J].中华介入放射学电子杂志,2018,6(1):40-45.
[4]YOON CJ,CHUNG JW,PARK JH.Transjugular intrahepatic portosystemic shunt for acute variceal bleeding in patients with viral liver cirrhosis:Predictors of early mortality[J].AJR Am JRoentgenol,2005,185(4):885-889.
[5]BUREAU C,MTIVIER S,D'AMICO M,et al.Serum bilirubin and platelet count:A simple predictive model for survival in patients with refractory ascites treated by TIPS[J].J Hepatol,2011,54(5):901-907.
[6]QI X,HE C,GUO W,et al.Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with variceal bleeding in liver cirrhosis:Outcomes and predictors in a prospective cohort study[J].Liver Int,2016,36(5):667-676.
[7]WANG LZ,LI X,SONG J,et al.Predictive factors for improved ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites[J].J Pract Radiol,2015,31(5):777-781.(in Chinese)王黎洲,李兴,宋杰,等.肝硬化合并顽固性腹水患者TIPS术后腹水改善的相关因素分析[J].实用放射学杂志,2015,31(5):777-781.
[8]JU W,ZHANG BJ,HAN GH.Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors[J].J Clin Hepatol,2016,32(8):1529-1533.(in Chinese)巨伟,张博静,韩国宏.经颈静脉肝内门体分流术治疗肝硬化顽固性腹水的长期效果及预后因素分析[J].临床肝胆病杂志,2016,32(8):1529-1533.
[9]NEGISHI M,WONGPALEE SP,SARKAR S,et al.A new lncRNA,APTR,associates with and represses the CDKN1A/p21 promoter by recruiting polycomb proteins[J].PLo S One,2014,9(4):e95216.
[10]YU F,ZHENG J,MAO Y,et al.Long non-coding RNA APTRpromotes the activation of hepatic stellate cells and the progression of liver fibrosis[J].Biochem Biophys Res Commun,2015,463(4):679-685.
[11]YU S,QI Y,JIANG J,et al.APTR is a prognostic marker in cirrhotic patients with portal hypertension during TIPS procedure[J].Gene,2018,645:30-33.
[12]TACKE F,ZIMMERMANN HW,BERRES ML,et al.Serum chemokine receptor CXCR3 ligands are associated with progression,organ dysfunction and complications of chronic liver diseases[J].Liver Int,2011,31(6):840-849.
[13]BERRES ML,ASMACHER S,LEHMANN J,et al.CXCL9 is a prognostic marker in patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt[J].J Hepatol,2015,62(2):332-339.
[14]BERRES ML,LEHMANN J,JANSEN C,et al.Chemokine(C-X-C motif)ligand 11 levels predict survival in cirrhotic patients with transjugular intrahepatic portosystemic shunt[J].Liver Int,2016,36(3):386-394.
[15]JANSEN C,EISCHEID H,GOERTZEN J,et al.The role of miRNA-34a as a prognostic biomarker for cirrhotic patients with portal hypertension receiving TIPS[J].PLo S One,2014,9(7):e103779
[16]PUGH RN,MURRAY-LYON IM,DAWSON JL,et al.Transection of the oesophagus for bleeding oesophageal varices[J].Br J Surg,1973,60(8):646-649.
[17]CHEN H,BAI M,QI X,et al.Child-Na score:A predictive model for survival in cirrhotic patients with symptomatic portal hypertension treated with TIPS[J].PLo S One,2013,8(11):e79637
[18]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33(2):464-470.
[19]WANG HQ,LIN Y,YAN Y.Clinical study on the significcance of hyponatremia in patients with cirrhotic ascites[J].J Clin Exp Med,2017,16(22):2275-2278.(in Chinese)王慧卿,林叶,严艳.肝硬化腹水合并低钠血症的临床研究[J].临床和实验医学杂志,2017,16(22):2275-2278.
[20]GABA RC,COUTURE PM,BUI JT,et al.Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation[J].J Vasc Interv Radiol,2013,24(3):411-420.
[21]ZHOU C,HOU C,CHENG D,et al.Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement:A systematic metaanalytic review[J].Int J Clin Exp Med,2015,8(8):13464-13472.
[22]PENG Y,QI X,GUO X.Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis:A systematic review and meta-analysis of observational studies[J].Medicine(Baltimore),2016,95(8):e2877.
[23]PROCOPE B,TANTAU M,BUREAU C.Are there any alternative methods to hepatic venous pressure gradient in portal hypertension assessment?[J].J Gastrointestin Liver Dis,2013,22(1):73-78.
[24]XU ZG,ZHAO YB,ZHENG YY,et al.Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis[J].J Clin Hepatol,2016,32(12):2326-2330.(in Chinese)徐征国,赵泳冰,郑媛钰,等.肝硬化患者经颈静脉肝内门体分流术后门静脉压力下降梯度与预后的关系[J].临床肝胆病杂志,2016,32(12):2326-2330.
[25]ASCHA M,ABUQAYYAS S,HANOUNEH I,et al.Predictors of mortality after transjugular portosystemic shunt[J].World JHepatol,2016,8(11):520-529.
[26]QI X,GUO W,HE C,et al.Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome:Techniques,indications and results on 51 Chinese patients from a single centre[J].Liver Int,2014,34(8):1164-1175.
[27]DELTENRE P,TRPO E,RUDLER M,et al.Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding:A systematic review and meta-analysis of controlled trials[J].Eur J Gastroenterol Hepatol,2015,27(9):e1-e9.
[28]RUDLER M,CLUZEL P,CORVEC TL,et al.Early-TIPSSplacement prevents rebleeding in high-risk patients with variceal bleeding,without improving survival[J].Aliment Pharmacol Ther,2014,40(9):1074-1080.
[29]PARVINIAN A,SHAH KD,COUTURE PM,et al.Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk[J].J Vasc Interv Radiol,2013,24(7):941-946.
[30]LI Y,WANG F,CHEN X,et al.Short outcome comparison of elderly patients versus nonelderly patients treated with transjugular intrahepatic portosystemic stent shunt:A propensity score matched cohort study[J].Medicine(Baltimore),2017,96(29):e7551.
[31]SURAWEERA D,JIMENEZ M,VIRAMONTES M,et al.Agerelated morbidity and mortality after transjugular intrahepatic portosystemic shunts[J].J Clin Gastroenterol,2017,51(4):360-363.
[32]NARDELLI S,LATTANZI B,TORRISI S,et al.Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J].Clin Gastroenterol Hepatol,2017,15(6):934-936.