肝硬化失代偿期经颈静脉肝内门体分流术后凝血功能障碍的相关因素分析

Analysis of the relevant factors of coagulation dysfunction after transjugular intrahepatic portosystemic shunt operation in patients with decompensated liver cirrhosis

目的：探讨肝硬化失代偿期经颈静脉肝内门体分流术（TIPS）后凝血功能障碍的相关因素。方法对68例因肝硬化失代偿期并发症，接受TIPS术治疗的患者的资料进行回顾性分析。以性别、年龄、生活质量评分（karnofsky performance status, KPS）、既往出血次数、术前出血量、术前凝血功能、术前血前白蛋白、术前Child-pugh分级、术前终末期肝病模型评分（Model for end-stage liver diease, MELD）、门静脉血栓、术前门静脉灌注量、术中肝内穿刺针数、分流前门静脉压力、分流的门静脉选择、分流道支架选择，术后门静脉灌注量变化、术后补充凝血因子作为观察对象，采用多元非条件logistic回归方法，分析影响术后凝血功能障碍的相关因素。结果术后发生凝血功能障碍31例（45.6%）。χ2检验表明年龄、既往出血次数、KPS、术前血前白蛋白及门静脉灌注量、分流的门静脉选择、术后门静脉灌注量与术后凝血功能障碍有关。经多元非条件logistic分析，得出术后发生凝血功能障碍概率（P）的方程：p= e4.987＋1.646x1-2.524x2-3.497x31＋e4.987＋1.646x1-2.524x2-3.497x3。公式中x1为既往出血次数，x2为术前血前白蛋白，x3为术后门静脉灌注量变化。结论术前血前白蛋白、出血次数、术后门静脉灌注量是TIPS术后凝血功能障碍的相关因素。

Objective To explore the factors affecting coagulopathy after the procedure of transjugular intrahepatic portosystemic shunt （TIPS） for the treatment of portal hypertension. Methods The clinical data of 68 cases of patients with cirrhosis and portal hypertension were retrospectively studied and the relationship of the multivariate factors affecting coagulopathy was analyzed by multivariate logistic regression model. Results Thirty-one cases presented coagulopathy accounting for 45.6%. Single variate analysis showed that the sign of coagulopathy related to age, pervious episodes of bleeding, karnofsky performance status（KPS）, Serum concentrations of prealbumin, distribution of the portal vein and portal vein flow volume before and after TIPS. Eventually the equations p= e4.987＋1.646x1-2.524x2-3.497x31＋e4.987＋1.646x1-2.524x2-3.497x3 were calculated by forward selection of multivariate logistic regression model （x1, 2, 3 represent pervious episodes of bleeding, prealbumin and portal vein flow volume after TIPS respectively）. Conclusions The related factors of blood coagulation dysfunction after TIPS were preoperative serum concentrations of prealbumin, pervious episodes of bleeding and postoperative portal vein perfusion.